Healthcare Provider Details

I. General information

NPI: 1669390860
Provider Name (Legal Business Name): CHELSEA CLARK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24242 BARQUERO DR
MISSION VIEJO CA
92691-4104
US

IV. Provider business mailing address

24242 BARQUERO DR
MISSION VIEJO CA
92691-4104
US

V. Phone/Fax

Practice location:
  • Phone: 949-637-3639
  • Fax:
Mailing address:
  • Phone: 949-637-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: