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General NPI Number Information
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NPI Number | 1861092447
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Entity Type | Individual
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Provider Name | ISAIAH DANIEL CLARK
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Gender | Male
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 19510 VAN BUREN BLVD # F3-1045
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City | RIVERSIDE
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State | CA
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Zip | 92508-9457
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Country | US
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Telephone | 951-215-6829
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Fax | 951-246-0734
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Provider Business Mailing Address
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Address Line | 22376 N MULLIGAN DR
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City | MARICOPA
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State | AZ
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Zip | 85138-2353
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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 |
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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 | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number | 1066261
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License Number State | CA
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