Individual
ALEXA P CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
46357 KOHINOOR WAY, TEMECULA, CA 92592-3323
(951) 345-5682
Mailing address
46357 KOHINOOR WAY, TEMECULA, CA 92592-3323
(951) 345-5682
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
F8304654
CA
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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