Clark, Justin

Clark, Justin is an individual health care provider with primary practice located at 1844 South St , Redding CA 96001-1809. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist, which is considered as his primary health care specialty. Clark, Justin can be contacted via phone (530) 243-4500.

Contact Information

Primary practice address
1844 South St Redding CA 96001-1809
Phone: (530) 243-4500
Fax: (530) 243-4554
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist 222Z00000X

Profile Details

NPI number 1285136846
LBN Legal business name Clark, Justin
Credentials BOCO
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2018
Last updated Mar 17th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285136846 NPPES
California Other PG0073849001 BLUE SHIELD OF CA
California MEDICAID GFC000180 BLUE SHIELD OF CA

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