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General NPI Number Information
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NPI Number | 1255577516
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Entity Type | Individual
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Provider Name | VIRLA BEATRICE CLARK C.R.N.A.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 30260 RANCHO VIEJO RD
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1561
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Country | US
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Telephone | 949-661-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 30260 RANCHO VIEJO RD
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1561
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Country | US
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Telephone | 949-661-1700
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 723
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 723
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License Number State | CA
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