MEDICARE: MRS. CATALINA FRANCESCA BETTY CLARK LM, CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	616	CA

General Provider Information

NPI Number	:	1093322406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATALINA FRANCESCA BETTY CLARK LM, CPM

Provider Business Mailing Address
First Line	:	3203 JOHNSTON AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-1520
Country	:	US
Telephone Number	:	310-867-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 JOHNSTON AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-1520
Country	:	US
Telephone Number	:	310-867-0769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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