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NPI Code Detail

MEDICARE: OLIVIA ISAAC-CLARK

MEDICARE: OLIVIA ISAAC-CLARK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1871436998
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA ISAAC-CLARK
Provider Business Mailing Address
First Line : 1500 S HAVEN AVE STE 240
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2973
Country : US
Telephone Number : 888-928-8860
Fax Number : 909-774-0113
Provider Business Practice Location Address
First Line : 1500 S HAVEN AVE STE 240
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2973
Country : US
Telephone Number : 888-928-8860
Fax Number : 909-774-0113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ OLIVIA ISAAC-CLARK ” Practice Location

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