Clark, Clelia Alexandra

Clark, Clelia Alexandra is an individual health care provider with primary practice located at 1165 Montgomery Dr , Santa Rosa CA 95405-4801. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is her primary health care specialty. Clark, Clelia Alexandra can be contacted via phone (707) 525-5300.

Contact Information

Primary practice address
1165 Montgomery Dr Santa Rosa CA 95405-4801
Phone: (707) 525-5300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X A176361 California

Profile Details

NPI number 1295294163
LBN Legal business name Clark, Clelia Alexandra
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 19th, 2019
Last updated Aug 3rd, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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