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1104692144
TATIANNA CLARK
RIVERSIDE, CA
NPI
1104692144
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: CA 63689)
Enumeration Date
2023-11-30
Last Update Date
2023-11-30
Business Address
TATIANNA CLARK
3940 POLK ST UNIT A
RIVERSIDE, CA 92505-1998
Phone number: 818-632-4265
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Mailing Address
TATIANNA CLARK
3940 POLK ST UNIT A
RIVERSIDE, CA 92505-1998
Phone number:
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