Healthcare Provider Details

I. General information

NPI: 1538760418
Provider Name (Legal Business Name): CHELSEA LA' BREA CLARK CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

IV. Provider business mailing address

12052 SW ROMA WAY
PORT ST LUCIE FL
34987-1076
US

V. Phone/Fax

Practice location:
  • Phone: 800-633-3445
  • Fax:
Mailing address:
  • Phone: 402-739-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number173540
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number199323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: