Individual provider · Type 1 NPI

Baly Juan Seo Park

Student in an Organized Health Care Education/Training Program · Farmington, CT

NPI number 1790403137 Active

Practice location

263 Farmington Ave
Farmington, CT 06030-0001

Call (679) 860-2000 Map

Mailing address

10 Talcott Ridge Rd Unit G
Farmington, CT 06032-3513

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000X13568 (CT)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1790403137

Baly Juan Seo Park's National Provider Identifier is 1790403137, issued on Aug 22, 2022. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Farmington, CT. The record was last updated on Sep 6, 2022.