Healthcare Provider Details

I. General information

NPI: 1780824490
Provider Name (Legal Business Name): ROBIN MICHAEL ANTHONY CLARKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ 420
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

UCLA MEDICAL CTR 757 WESTWOOD PLAZA
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6766
  • Fax: 310-794-2113
Mailing address:
  • Phone: 310-206-6766
  • Fax: 310-794-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA106915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: