Individual
DR. BHAVISHYA SURAPANENI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
35 CASA ST STE 130, SAN LUIS OBISPO, CA 93405-1887
(805) 541-1422
(805) 541-1215
Mailing address
35 CASA ST STE 130, SAN LUIS OBISPO, CA 93405-1887
(805) 541-1422
(805) 541-1215
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
155364
CA
Other
Enumeration date
05/14/2016
Last updated
10/04/2022
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