Individual
MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
140 SYLVESTER RD, SAN DIEGO, CA 92106-3521
(619) 553-8719
Mailing address
25106 CORN FIELD CT, MENIFEE, CA 92584-8562
(951) 679-3324
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/18/2007
Last updated
02/01/2008
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