Clark, Mavis J.

Clark, Mavis J. is an individual health care provider with primary practice located at 921 W Avenue J Ste C , Lancaster CA 93534-3443. She recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as her primary health care specialty. Clark, Mavis J. can be contacted via phone (616) 949-0131.

Contact Information

Primary practice address
921 W Avenue J Ste C Lancaster CA 93534-3443
Phone: (616) 949-0131
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X

Profile Details

NPI number 1942471537
LBN Legal business name Clark, Mavis J.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 21st, 2008
Last updated Jan 31st, 2019 - about 6 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 1942471537 NPPES
California MEDICAID 00007473

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