Healthcare Provider Details

I. General information

NPI: 1326572132
Provider Name (Legal Business Name): JUANETTE G CLARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANETTE CLARK NP

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25470 MEDICAL CENTER DR STE 105
MURRIETA CA
92562-4901
US

IV. Provider business mailing address

25470 MEDICAL CENTER DR STE 105
MURRIETA CA
92562-4901
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4600
  • Fax: 951-514-2542
Mailing address:
  • Phone: 951-698-4600
  • Fax: 951-514-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95002760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: