Clark, Mavis J.
Clark, Mavis J. is an individual health care provider with primary practice located at 921 W Avenue J Ste C , Lancaster CA 93534-3443. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Clark, Mavis J. can be contacted via phone (616) 949-0131.Contact Information
Primary practice address
921 W Avenue J Ste C
Lancaster CA 93534-3443
Phone: (616) 949-0131
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X |
Profile Details
| NPI number | 1942471537 |
|---|---|
| LBN Legal business name | Clark, Mavis J. |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 21st, 2008 |
| Last updated | Jan 31st, 2019 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942471537 | NPPES |
| California | MEDICAID | 00007473 |
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