Active NPI
Elisa M. Park, D.O.
- Psychiatry Physician
- Sylmar, CA
National Provider Identifier
1285923003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 20A12656
- Practice address
- 14445 Olive View Dr
Sylmar, CA 91342-1437 - Phone
- (747) 210-4341
- NPI assigned
- Apr 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 20A12656 | CA | Primary |
Addresses
Primary practice location
14445 Olive View Dr
Sylmar, CA 91342-1437
Mailing address
23400 Vanowen St
West Hills, CA 91307-2439
Phone (818) 312-3411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A12656 | CA | MD | Psychiatry Physician |
| 12656 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521590400000",
"number": "1285923003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23400 VANOWEN ST",
"city": "WEST HILLS",
"state": "CA",
"postal_code": "913072439",
"telephone_number": "818-312-3411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14445 OLIVE VIEW DR",
"city": "SYLMAR",
"state": "CA",
"postal_code": "913421437",
"telephone_number": "747-210-4341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ELISA",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-01",
"last_updated": "2018-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "20A12656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sylmar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.