Individual
BARBARA LATREASE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2401 RIDGELEY, #4, LOS ANGELES, CA 90016
(323) 932-9646
(323) 932-9646
Mailing address
2401 RIDGELEY, #4, LOS ANGELES, CA 90016
(323) 932-9646
(323) 932-9646
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA19103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA19103
MEDICAL BOARD OF CA
CA
Enumeration date
01/08/2008
Last updated
11/08/2012
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