Basic Information
| Provider Information | |||||||||
| NPI: | 1518145002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKS | ||||||||
| FirstName: | DION | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10470 OLD PLACERVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2725 CAPITOL AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162629440 | ||||||||
| FaxNumber: | 9162629445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 15440 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 163WP0808X | 483525 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.