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General NPI Number Information
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NPI Number | 1497784110
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Entity Type | Individual
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Provider Name | CLARK STUART PADDOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 23962 ALICIA PKWY SUITE I1
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City | MISSION VIEJO
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State | CA
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Zip | 92691-3940
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Country | US
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Telephone | 949-452-7699
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 N HELIOTROPE DR
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City | SANTA ANA
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State | CA
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Zip | 92706-2538
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Country | US
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Telephone | 714-624-0772
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A51251
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License Number State | CA
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