Healthcare Provider Details

I. General information

NPI: 1790078616
Provider Name (Legal Business Name): MURRAY CLARKE L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WILSHIRE BLVD SUITE 405
SANTA MONICA CA
90401-1872
US

IV. Provider business mailing address

900 WILSHIRE BLVD SUITE 405
SANTA MONICA CA
90401-1872
US

V. Phone/Fax

Practice location:
  • Phone: 310-395-8363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberAC3261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: