Individual
CHRISTINA MARIE CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP (C)
Contact information
Practice address
808 W 58TH ST, LOS ANGELES, CA 90037-3632
(323) 541-1600
Mailing address
3153 ROLLINGS AVE, THOUSAND OAKS, CA 91360-6433
(805) 990-3730
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95015295
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
95015295
CA
Other
Enumeration date
01/23/2021
Last updated
07/17/2025
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