Individual
MRS. ALICIA SUZANNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAP, PA-C
Contact information
Practice address
123 S ALVARADO ST, LOS ANGELES, CA 90057-2201
(213) 989-7700
Mailing address
123 S ALVARADO ST, LOS ANGELES, CA 90057-2201
(213) 989-7700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
51943
CA
Other
Enumeration date
03/25/2014
Last updated
05/21/2015
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