Individual
JESSICA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5664 CAHUENGA BLVD, NORTH HOLLYWOOD, CA 91601-2103
(818) 823-3930
Mailing address
5664 CAHUENGA BLVD, NORTH HOLLYWOOD, CA 91601-2103
(818) 823-3930
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
174H00000X
Health Educator
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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