Individual
CAROLYN BENTLEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
261 E WILLOW ST, SUITE C, LONG BEACH, CA 90806-2637
(562) 290-0212
Mailing address
261 E WILLOW ST, SUITE C, LONG BEACH, CA 90806-2637
(562) 290-0212
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
801931
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33-0150193
MEDI-CAL
CA
Enumeration date
12/06/2011
Last updated
12/06/2011
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