=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942681143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALESSANDRA CLARK D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2015
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2802 N ALVERNON WAY STE 300
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-481-2453
-----------------------------------------------------
Fax | 760-266-6177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2802 N ALVERNON WAY STE 300
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-481-2453
-----------------------------------------------------
Fax | 760-266-6177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R2518
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 007774
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------