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General NPI Number Information
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NPI Number | 1508630203
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Entity Type | Individual
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Provider Name | JOSEFINA CLARK CNM
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Gender | Female
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 5831 FIRESTONE BLVD STE E
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City | SOUTH GATE
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State | CA
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Zip | 90280-3718
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Country | US
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Telephone | 323-521-5887
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Fax |
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Provider Business Mailing Address
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Address Line | 12115 MORNING AVE
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City | DOWNEY
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State | CA
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Zip | 90242-2325
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Country | US
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Telephone | 310-722-5383
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 236395
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License Number State | CA
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