Individual
DR. MARY ELIZABETH REVILLA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2333 BUCHANAN ST, SUITE 5823, SAN FRANCISCO, CA 94115-1925
(415) 644-5752
Mailing address
2333 BUCHANAN ST, SUITE 5823, SAN FRANCISCO, CA 94115-1925
(415) 644-5752
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A98304
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A98304
CALIFORNIA STATE LICENSE
CA
01
—
MD-12890
HAWAII MEDICAL LICENSE
HI
Enumeration date
11/13/2006
Last updated
01/13/2022
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