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Organization
LORI CLARK M.D., INC.
Active
Organization
LORI CLARK M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LYNN CLARK M.D. (PHYSICIAN)
(949) 588-7262
Entity
Organization
Contact information
Practice address
23521 PASEO DE VALENCIA STE 108, LAGUNA HILLS, CA 92653-3137
(949) 588-7262
(949) 588-7260
Mailing address
23521 PASEO DE VALENCIA STE 108, LAGUNA HILLS, CA 92653-3137
(949) 588-7262
(949) 588-7260
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A82608
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A82608
CALOPTIMA DIRECT
CA
01
—
00A826080
BLUE SHIELD OF CA
CA
05
—
00A826080
—
CA
Enumeration date
07/06/2006
Last updated
04/20/2008
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