Individual
MRS. SUDABEH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8275 S SUPERNAL WAY, COTTONWOOD HEIGHTS, UT 84121-6023
(310) 963-9404
Mailing address
8275 S SUPERNAL WAY, COTTONWOOD HEIGHTS, UT 84121-6023
(310) 963-9404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11172710-1206
UT
363A00000X
Physician Assistant
Primary
PA 19540
CA
Other
Enumeration date
07/02/2007
Last updated
12/28/2022
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