Individual
MR. KEITH ANDREW CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPT, CMT
Contact information
Practice address
3975 5TH AVE, SUITE 213, SAN DIEGO, CA 92103-3101
(619) 906-7055
(619) 639-8269
Mailing address
113 W G ST # 819, SAN DIEGO, CA 92101-6096
(619) 906-7055
(619) 639-8269
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
67117
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346616208
NPPES
CA
01
—
67117
CALIFORNIA MASSAGE THERAPY COUNCIL
CA
Enumeration date
08/14/2015
Last updated
02/12/2026
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