| Camellia P Clark Md Inc | |
|
11515 El Camino Real Suite #100 San Diego CA 92130 | |
| (858) 263-5947 | |
| Not Available |
| Full Name | Camellia P Clark Md Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11515 El Camino Real, San Diego, California |
| Authorized Official Name and Position | Camellia Clark (OWNER) |
| Authorized Official Contact | 8582635947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Camellia P Clark Md Inc 4240 Kearny Mesa Rd Ste 120 San Diego CA 92111-3771 Ph: (858) 263-5947 | Camellia P Clark Md Inc 11515 El Camino Real Suite #100 San Diego CA 92130 Ph: (858) 263-5947 |
| NPI Number | 1689421471 |
|---|---|
| Provider Enumeration Date | 05/01/2024 |
| Last Update Date | 05/01/2024 |
| Certification Date | 04/22/2024 |
| Medicare PECOS PAC ID | 0143763128 |
|---|---|
| Medicare Enrollment ID | O20241029004088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689421471 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Camellia P Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174624399 PECOS PAC ID: 4587761994 Enrollment ID: I20070519000077 |
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