Individual
MR. CRAIG ANSON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3579 ARLINGTON AVE STE 300, RIVERSIDE, CA 92506-3915
(951) 341-9333
(951) 341-9330
Mailing address
5911 GRINNELL DR, JURUPA VALLEY, CA 92509-7046
(951) 733-4650
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
10026
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10026
PHYSICIAN ASSISTANT
CA
Enumeration date
01/05/2023
Last updated
01/05/2023
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