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Baly Juan Seo Park
Student in an Organized Health Care Education/Training Program in Farmington, Connecticut
NPI 1790403137

Baly Juan Seo Park is a Student in an Organized Health Care Education/Training Program based in Farmington, CT. Baly Juan Seo Park practices in Farmington, CT. The NPI Number for Baly Juan Seo Park is 1790403137 and holds a License No. 13568 (Connecticut).

The current practice location address for Baly Juan Seo Park is 263 Farmington Ave, Farmington, CT and can be reached out via phone at 679-860-2000.

Location: 263 Farmington Ave, Farmington, CT, 06032-3513
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790403137
Provider Name
Baly Juan Seo Park
Credential
Provider Entity Type
Individual
Gender
Male
Address
263 Farmington Ave, Farmington, CT, 06032-3513
Phone Number
679-860-2000
Fax Number
Provider Enumeration Date
08/22/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
263 Farmington Ave
City
Farmington
State
Connecticut
Zip
06030-0001
Phone Number
679-860-2000
Fax Number
person
Provider Business Mailing Address Details
Address
263 Farmington Ave
City
Farmington
State
Connecticut
Zip
06030-0001
Phone Number
679-860-2000
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
13568 (Connecticut)
Definition
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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