Individual
TATIANNA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3940 POLK ST UNIT A, RIVERSIDE, CA 92505-1998
(818) 632-4265
Mailing address
3940 POLK ST UNIT A, RIVERSIDE, CA 92505-1998
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
63689
CA
Other
Enumeration date
11/30/2023
Last updated
11/30/2023
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