Individual
CRYSTAL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
631 MAPLE AVE, LOS ANGELES, CA 90014-2211
(213) 673-3059
Mailing address
631 MAPLE AVE, LOS ANGELES, CA 90014-2211
(213) 673-3059
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
CA
Other
Enumeration date
06/28/2018
Last updated
03/01/2021
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