Individual
LISA MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
727 SHASTA ST, REDWOOD CITY, CA 94063-2124
(650) 599-1071
Mailing address
727 SHASTA ST, REDWOOD CITY, CA 94063-2124
(650) 599-1071
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/28/2022
Last updated
01/18/2023
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