Individual
STACEY J CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
82013 DOCTOR CARREON BLVD STE H, INDIO, CA 92201-5832
(760) 610-8398
(442) 300-2925
Mailing address
82013 DOCTOR CARREON BLVD STE H, INDIO, CA 92201-5832
(760) 610-8398
(442) 300-2925
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E5243
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
DP00283
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150541
—
OR
Enumeration date
07/14/2005
Last updated
04/16/2025
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