Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 616 | CA |
NPI | 1093322406 |
---|---|
Provider Name | Mrs. Catalina Francesca Betty Clark |
First Address | Redondo Beach, CA 90278-1520 |
Second Address | Redondo Beach, CA 90278-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2020 |
Last Update Date | 29/09/2020 |