Provider Demographics
NPI:1639877814
Name:CLARK, BRIANNA YVONNE (ND, MS)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:YVONNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:ND, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 PASEO LUCIDO APT 1024
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6275
Mailing Address - Country:US
Mailing Address - Phone:951-816-1548
Mailing Address - Fax:
Practice Address - Street 1:4110 SORRENTO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1429
Practice Address - Country:US
Practice Address - Phone:858-246-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education