Individual
DIANNE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
360 KIELY BLVD, SAN JOSE, CA 95129-1347
(408) 693-7256
Mailing address
PO BOX 54375, SAN JOSE, CA 95154-0375
(408) 693-7256
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
74835
CA
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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