Individual
IAN JAMES CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
26340 CAMINO DE VIS APT M, SAN JUAN CAPISTRANO, CA 92675-5123
(818) 224-8574
Mailing address
26340 CAMINO DE VIS APT M, SAN JUAN CAPISTRANO, CA 92675-5123
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
59748
CA
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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