Individual
MR. DANIEL JOSEPH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
2150 STOCKTON BLVD, SACRAMENTO, CA 95817-1337
(916) 875-1000
Mailing address
3101 E LATHROP RD, MANTECA, CA 95336-8112
(209) 417-0638
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 23702
CA
Other
Enumeration date
08/03/2006
Last updated
05/23/2012
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