Healthcare Provider Details

I. General information

NPI: 1831428028
Provider Name (Legal Business Name): CLAUDENE KOROS STARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14031 STAGECOACH TRL
MOORPARK CA
93021-3503
US

IV. Provider business mailing address

14031 STAGECOACH TRL
MOORPARK CA
93021-3503
US

V. Phone/Fax

Practice location:
  • Phone: 818-518-5644
  • Fax: 805-778-8886
Mailing address:
  • Phone: 818-518-5644
  • Fax: 805-778-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA45158
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0310180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: