LILY PARK

MODESTO, CA
NPI1124333455
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207N00000X Dermatology
(Licence: CA  12765)
Additional Taxonomies207R00000X Internal Medicine
(Licence: CA  20A12765)
207R00000X Internal Medicine
(Licence: MI  5101018747)
207R00000X Internal Medicine
(Licence: OR  DO184048)
208M00000X Hospitalist
(Licence: CA  20A12765)
Enumeration Date2010-08-11
Last Update Date2024-08-08
Business Address
LILY PARK D.O.
600 COFFEE RD
MODESTO, CA 95355-4201
Phone number: 209-521-6097
Mailing Address
LILY PARK D.O.
3105 CEDAR RAVINE RD STE 201
PLACERVILLE, CA 95667-6561
Phone number: 530-626-1602