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General NPI Number Information
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NPI Number | 1437157260
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Entity Type | Individual
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Provider Name | STACEY J CLARKE D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 82013 DOCTOR CARREON BLVD STE H
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City | INDIO
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State | CA
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Zip | 92201-5832
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Country | US
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Telephone | 760-610-8398
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Fax | 442-300-2925
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Provider Business Mailing Address
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Address Line | 82013 DOCTOR CARREON BLVD STE H
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City | INDIO
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State | CA
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Zip | 92201-5832
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Country | US
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Telephone | 760-610-8398
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Fax | 442-300-2925
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00283
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5243
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E5243
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License Number State | CA
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