Healthcare Provider Details

I. General information

NPI: 1548460603
Provider Name (Legal Business Name): MARK F CLAPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 VANDEVER AVE
SAN DIEGO CA
92120-3315
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR - PHR SYSTEMS
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-5000
  • Fax: 626-405-6768
Mailing address:
  • Phone: 626-405-7914
  • Fax: 626-405-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberG59619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: