Individual
MISS CHARISMA MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
4281 KATELLA AVE STE 120, LOS ALAMITOS, CA 90720-3592
(714) 503-6850
Mailing address
4281 KATELLA AVE STE 120, LOS ALAMITOS, CA 90720-3592
(714) 503-6850
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN209103
CA
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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