Individual
DR. AMIZETTA CAROL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10 WOODLAND RD, SAINT HELENA, CA 94574-9554
(707) 963-3611
Mailing address
10 WOODLAND RD, SAINT HELENA, CA 94574-9554
(808) 287-8496
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A175677
CA
2084P0800X
Psychiatry Physician
Primary
A175677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A175677
MEDICAL LICENSE
CA
Enumeration date
05/13/2016
Last updated
03/07/2023
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