Vernon Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10853 Issued in CA

Practice address

2400 E 8TH St
National City, CA 91950

Phone

(619) 267-4255

Fax

(619) 267-7937

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charles R. Johnson MD, Inc.

  • Internal Medicine Physician
  • National City, CA
  • NPI 1528152717
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104910389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15160",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921755160",
            "telephone_number": "619-267-4255",
            "fax_number": "619-267-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E 8TH ST",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "91950",
            "telephone_number": "619-267-4255",
            "fax_number": "619-267-7937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "VERNON",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA10853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clara Lucky Polak MD, Inc.
• Clara Lucy Polak, M.D. Inc.
• Andrew R Clark, PH.D.
• Chris Clark, DC
• Pilar Marie Clark, ASW
• William Clark, DPM
• Ryan Cobos, PTA
• Philip R Cohen, MD
• Debra Marie Cole, NP
• Vanessa Kristen Comer

• Physician Assistant in National City, CA
• Providers in National City, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.