Provider Demographics
NPI:1710052907
Name:CLARK, MARLENE (RD)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CEDARS-SINAI MEDICAL CENTER
Mailing Address - Street 2:8700 BEVERLY BLVD, FOOD & NUTRITION DEPT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-3444
Mailing Address - Fax:310-423-0189
Practice Address - Street 1:CEDARS-SINAI MEDICAL CENTER
Practice Address - Street 2:8723 ALDEN DRIVE, SUITE 290
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-3444
Practice Address - Fax:310-423-0189
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL426024133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered