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General NPI Number Information
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NPI Number | 1033616032
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Entity Type | Individual
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Provider Name | ABIGAIL CLARK
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Gender | Female
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 9500 GILMAN DR # 9116A
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City | LA JOLLA
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State | CA
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Zip | 92093
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Country | US
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Telephone | 619-471-0259
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 GILMAN DR # 851
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City | LA JOLLA
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State | CA
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Zip | 92093-5004
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Country | US
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Telephone | 571-228-8139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A165554
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License Number State | CA
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