| Lori Clark M.d., Inc. | |
|
23521 Paseo De Valencia Ste 108 Laguna Hills CA 92653-3137 | |
| (949) 588-7262 | |
| (949) 588-7260 |
| Full Name | Lori Clark M.d., Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 23521 Paseo De Valencia Ste 108, Laguna Hills, California |
| Authorized Official Name and Position | Lori Lynn Clark (PHYSICIAN) |
| Authorized Official Contact | 9495887262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lori Clark M.d., Inc. 23521 Paseo De Valencia Ste 108 Laguna Hills CA 92653-3137 Ph: (949) 588-7262 | Lori Clark M.d., Inc. 23521 Paseo De Valencia Ste 108 Laguna Hills CA 92653-3137 Ph: (949) 588-7262 |
| NPI Number | 1619908589 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 4385654144 |
|---|---|
| Medicare Enrollment ID | O20060425000390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619908589 | NPI | - | NPPES |
| 00A826080 | Other | CA | BLUE SHIELD OF CA |
| 00A826080 | Medicaid | CA | |
| 00A82608 | Other | CA | CALOPTIMA DIRECT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A82608 (California) | Primary |
| Provider Name | Lori L Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972634897 PECOS PAC ID: 6709859796 Enrollment ID: I20040817001422 |
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