Active NPI
Abigail Clark
- Psychiatry Physician
- San Diego, CA
National Provider Identifier
1033616032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A165554
- Practice address
- 1880 Camino de la Reina # 1147
San Diego, CA 92108-1539 - Phone
- (619) 688-8111
- NPI assigned
- Apr 7, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A165554 | CA | Primary |
Addresses
Primary practice location
1880 Camino de la Reina # 1147
San Diego, CA 92108-1539
Mailing address
1880 Camino de la Reina # 1147
San Diego, CA 92108-1539
Phone (619) 688-8111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 5, 2024 through Mar 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A165554 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773619200000",
"number": "1033616032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1880 CAMINO DE LA REINA # 1147",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921081539",
"telephone_number": "619-688-8111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 CAMINO DE LA REINA # 1147",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921081539",
"telephone_number": "619-688-8111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ABIGAIL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-07",
"last_updated": "2026-03-16",
"certification_date": "2026-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A165554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.