Clark, Mary Elizabeth Revilla
Clark, Mary Elizabeth Revilla is an sole proprietor health care provider with primary practice located at 2333 Buchanan St Suite 5823, San Francisco CA 94115-1925. She recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as her primary health care specialty. Clark, Mary Elizabeth Revilla can be contacted via phone (415) 644-5752.Contact Information
Primary practice address
2333 Buchanan St Suite 5823
San Francisco CA 94115-1925
Phone: (415) 644-5752
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | A98304 | California |
Profile Details
| NPI number | 1225109770 |
|---|---|
| LBN Legal business name | Clark, Mary Elizabeth Revilla |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 13th, 2006 |
| Last updated | Jan 13th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225109770 | NPPES |
| California | Other | A98304 | CALIFORNIA STATE LICENSE |
| California | Other | MD-12890 | CALIFORNIA STATE LICENSE |
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