Individual ProviderAmanda Elizabeth ParkNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address757 Westwood Plz, Los Angeles, CA 90095-8358(310) 825-9111(310) 423-1160PECOS EnrollmentBased on the most recent information from CMS, provider Amanda Elizabeth Park does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:00 PM.Profile DetailsProvider ID1134781305Provider TypeIndividualFull NamePark, Amanda ElizabethCredentialNPGenderFemaleSole ProprietorNoEnumeration Date7/8/2019Last Updated6/7/2023Contact InformationPractice LocationPractice Address757 Westwood Plz, Los Angeles, CA 90095-8358Phone(310) 825-9111FaxUnlisted FaxMailing LocationMailing Address4140 W 190th St, Torrance, CA 90504-5513Phone(310) 423-1160Fax(310) 423-4646Provider TaxonomiesCodeDescriptionLicenseCode363LA2100XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense95012049CaliforniaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense95012049California