MEDICARE: DR. CYNTHIA LYNNE CLARK M.D.

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	207Q00000X	Family Medicine Physician	A060094	CA

General Provider Information

NPI Number	:	1487690244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA LYNNE CLARK M.D.

Provider Business Mailing Address
First Line	:	130 SUTTER ST FL 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4009
Country	:	US
Telephone Number	:	154-658-6791
Fax Number	:	415-520-0904

Provider Business Practice Location Address
First Line	:	468 ELLIS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1928
Country	:	US
Telephone Number	:	650-227-1150
Fax Number	:	650-227-1107

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/29/2018

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