Search › California › 171100000X
Se Park
NPI 1275178055 · on the registry since 2019 · sole proprietor
Practice
- Address
- 15541 Williams St Apt D4
Tustin, CA 92780 - Phone
- (714) 902-5959
Additional practice sites
- 1440 S Anaheim Blvd # G1, Anaheim, CA
Registry record
- Primary taxonomy
- 171100000X
171100000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-11-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California