MEDICARE: JOSEFINA CLARK CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	236395	CA

General Provider Information

NPI Number	:	1508630203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFINA CLARK CNM

Provider Business Mailing Address
First Line	:	12115 MORNING AVE
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-2325
Country	:	US
Telephone Number	:	310-722-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	5831 FIRESTONE BLVD STE E
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-3718
Country	:	US
Telephone Number	:	323-521-5887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	01/22/2024

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