Healthcare Provider Details

I. General information

NPI: 1932090057
Provider Name (Legal Business Name): ANGEL JUSON CLARK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 N ZARAGOZA RD STE A4
EL PASO TX
79936-8040
US

IV. Provider business mailing address

5825 FLOUNDER DR
EL PASO TX
79924-5603
US

V. Phone/Fax

Practice location:
  • Phone: 915-373-9181
  • Fax:
Mailing address:
  • Phone: 915-373-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT041445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: