Healthcare Provider Details

I. General information

NPI: 1851249213
Provider Name (Legal Business Name): RAMON CLARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732A CHENERY ST
SAN FRANCISCO CA
94131-2907
US

IV. Provider business mailing address

30 CANYON DR
SAN FRANCISCO CA
94112-4530
US

V. Phone/Fax

Practice location:
  • Phone: 415-366-3559
  • Fax:
Mailing address:
  • Phone: 267-428-6348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4066361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: