Individual
GUISELLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1225 15TH ST, A454, SANTA MONICA, CA 90404-1101
(310) 319-4598
(310) 319-4908
Mailing address
757 WESTWOOD PLZ, SUITE 7501, LOS ANGELES, CA 90095-8358
(310) 267-9643
(310) 267-3840
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A114924
CA
208M00000X
Hospitalist Physician
Primary
A114924
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124254024
CCS PANELED
CA
05
—
1124254024
—
CA
Enumeration date
06/05/2009
Last updated
11/30/2021
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