Individual
CLARK E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9820 WILLOW CREEK RD, STE 370, SAN DIEGO, CA 92131-1112
(858) 530-9112
(858) 530-9118
Mailing address
9820 WILLOW CREEK RD, STE 370, SAN DIEGO, CA 92131-1112
(858) 530-9112
(858) 530-9118
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G49105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00491050
—
CA
Enumeration date
10/20/2006
Last updated
04/28/2009
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