Provider Demographics
NPI:1821837139
Name:CLARK, PARIS DAWN (DACM, CMT)
Entity type:Individual
Prefix:MRS
First Name:PARIS
Middle Name:DAWN
Last Name:CLARK
Suffix:
Gender:F
Credentials:DACM, CMT
Other - Prefix:MISS
Other - First Name:PARIS
Other - Middle Name:DAWN
Other - Last Name:TOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DACM, CMT
Mailing Address - Street 1:2525 CAMINO DEL RIO S STE 245
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3775
Mailing Address - Country:US
Mailing Address - Phone:858-337-6182
Mailing Address - Fax:
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 245
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3775
Practice Address - Country:US
Practice Address - Phone:858-337-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 390200000X
CA59395171400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist
No171400000XOther Service ProvidersHealth & Wellness Coach
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program