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General NPI Number Information
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NPI Number | 1275417933
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Entity Type | Individual
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Provider Name | REAGAN CLARK AA
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 300 S PARK AVE STE 750
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City | POMONA
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State | CA
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Zip | 91766-1553
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Country | US
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Telephone | 909-326-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 27224 WOODGLEN LN
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4534
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Country | US
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Telephone | 951-488-4819
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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