Clark, Leroy S

Clark, Leroy S is an individual health care provider with primary practice located at 18344 Clark Street Suite 101, Tarzana CA 91356. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Clark, Leroy S can be contacted via phone (818) 881-9811.

Contact Information

Primary practice address
18344 Clark Street Suite 101 Tarzana CA 91356
Phone: (818) 881-9811
Fax: (818) 881-1638
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X G14247 California

Profile Details

NPI number 1982643508
LBN Legal business name Clark, Leroy S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Nov 27th, 2007 - about 18 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 1982643508 NPPES
California Other 00G142470 BLUE SHIELD
California MEDICAID 00G142470 BLUE SHIELD

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