Healthcare Provider Details

I. General information

NPI: 1205800406
Provider Name (Legal Business Name): BARBARA JEAN CLARK REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA NORTHERN CALIFORNIA HEALTH CARE SYSTEM 150 MUIR RD
MARTINEZ CA
94553
US

IV. Provider business mailing address

1505 HOOD RD #D
SACRAMENTO CA
95825-2392
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 916-564-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR316866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: