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General NPI Number Information
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NPI Number | 1831933266
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Entity Type | Organization
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Legal Business Name | CLEAR KETAMINE PLUS PSYCHIATRY
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 5743 CORSA AVE STE 114
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4072
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Country | US
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Telephone | 805-219-7870
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Fax | 805-244-0479
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Provider Business Mailing Address
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Address Line | 5743 CORSA AVE STE 114
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4072
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Country | US
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Telephone | 805-219-7870
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Fax | 805-244-0479
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | DR. MARC SMITH
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Credential | MD
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Telephone | 805-219-7870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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