Search › California › 101Y00000X
Keith Park
NPI 1710101092 · on the registry since 2007 · sole proprietor
Practice
- Address
- 908 Park Ave
Calimesa, CA 92320 - Phone
- (909) 518-3886
- Fax
- (909) 790-9333
Registry record
- Primary taxonomy
- 101Y00000X
101Y00000X
- Also registered as
- 103T00000X
- Licence states on file
- NM, CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-09-11
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