Individual
AIDAN M CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1725 W MONTECITO WAY, SAN DIEGO, CA 92103-1227
(619) 210-9291
Mailing address
1725 W MONTECITO WAY, SAN DIEGO, CA 92103-1227
(619) 564-7463
(619) 564-7463
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
G64292
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
G64292
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
G64292
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G642920
BLUE SHIELD
—
Enumeration date
07/28/2006
Last updated
07/28/2022
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