NPI
Keith Park
NPI 1710101092
Read from the NPPES registry on October 25, 2026.
Facts
- Status
- Active
- Type
- Individual
- Enumeration date
- 2007-04-11
- Last updated
- 2025-09-11
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Specialties
Licenses
- License NM
- 0085201
- License CA
- PSY 18884
Location
- Practice location
- 908 Park Ave
- City
- Calimesa CA
- Postal code
- 92320-1148
- Phone
- (909) 518-3886
- Fax
- (909) 790-9333
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. Confirm on OIG's online search.
Nearby
Other NPIs in Calimesa, CA. 86 records in the public file.
Public data from NPPES and CMS. Not a credentialing determination.
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