Provider Demographics
NPI:1093322406
Name:CLARK, CATALINA FRANCESCA BETTY (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:CATALINA
Middle Name:FRANCESCA BETTY
Last Name:CLARK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1520
Mailing Address - Country:US
Mailing Address - Phone:310-867-0769
Mailing Address - Fax:
Practice Address - Street 1:3203 JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1520
Practice Address - Country:US
Practice Address - Phone:310-867-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife