Bruce Park, MD
Dermatology in La Palma, CA. Organization (NPI-2).
NPI number1932272846
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1932272846
- Entity type
- Organization (NPI-2)
- Legal business name
- Bruce Park, MD
- Organization subpart
- No
- Enumeration date
- Nov 16, 2006
- Last updated
- Aug 22, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | A64842 | CA | Yes |
Practice location
7872 Walker StSuite 108
La Palma, CA 90623-1796
Phone 714-562-0542
Mailing address
Po Box 3430Cerritos, CA 90703-3430
Phone 714-562-0542
Authorized official
Bruce S Park
Owner
7145620542
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 5 Dermatology Physician providers in La Palma · All 763 providers in La Palma
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