Clark, Larry Dean

Clark, Larry Dean is an sole proprietor health care provider with primary practice located at 811 Grand Ave , Sacramento CA 95838-3466. He recently has only one registered license in Other Service Providers / Contractor, which is considered as his primary health care specialty. Clark, Larry Dean can be contacted via phone (916) 922-9868.

Contact Information

Primary practice address
811 Grand Ave Sacramento CA 95838-3466
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Contractor 171W00000X

Profile Details

NPI number 1578263117
LBN Legal business name Clark, Larry Dean
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 2nd, 2023
Last updated Mar 2nd, 2023 - about 3 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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Identifiers

StateTypeNumberIssuer
All States NPI 1578263117 NPPES
California MEDICAID 0

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