Provider Demographics
NPI:1508630203
Name:CLARK, JOSEFINA (CNM)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 MORNING AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2325
Mailing Address - Country:US
Mailing Address - Phone:310-722-5383
Mailing Address - Fax:
Practice Address - Street 1:5831 FIRESTONE BLVD STE E
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3718
Practice Address - Country:US
Practice Address - Phone:323-521-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236395176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife