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General NPI Number Information
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NPI Number | 1790010171
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Entity Type | Organization
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Legal Business Name | CLARKNET INC.
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 2081 N OXNARD BLVD STE 228
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City | OXNARD
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State | CA
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Zip | 93036-2964
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Country | US
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Telephone | 805-754-1425
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Fax | 805-512-7038
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Provider Business Mailing Address
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Address Line | 2081 N OXNARD BLVD STE 228
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City | OXNARD
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State | CA
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Zip | 93036-2964
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Country | US
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Telephone | 805-754-1425
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Fax | 805-512-7038
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND MICHAEL STENT
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Credential | MD
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Telephone | 805-754-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A22472
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License Number State | CA
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