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General NPI Number Information
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NPI Number | 1801653597
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Entity Type | Organization
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Legal Business Name | WILLIAM CLARK PODIATRY PC
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 590 S MAGNOLIA AVE
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City | EL CAJON
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State | CA
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Zip | 92020-6011
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Country | US
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Telephone | 619-442-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD # 889647
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM CLARK
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Credential | DPM
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Telephone | 252-801-7686
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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 |
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License Number State |
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