Individual
TIMOTHY H CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
8432 MAGNOLIA AVE, RIVERSIDE, CA 92504
(951) 552-8512
Mailing address
243 MONTANA DEL LAGO DRIVE, RANCHO SANTA MARGARITA, CA 92688
(714) 883-6133
(951) 689-4754
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099302424
NATA-BOC
—
01
—
930906
NATA MEMBER NUMBER
—
Enumeration date
09/01/2016
Last updated
09/01/2016
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