Active NPI
Larry Andrew Clark
- Surgical Assistant
- Beverly Hills, CA
National Provider Identifier
1174884456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 124156
- Practice address
- 435 N Roxbury Dr
Ste 100
Beverly Hills, CA 90210-5027 - Phone
- (310) 855-8058
- Fax
- (310) 855-8059
- NPI assigned
- Jun 4, 2012
- Last updated
- Jun 4, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 124156 | CA | Primary |
Addresses
Primary practice location
435 N Roxbury Dr
Ste 100
Beverly Hills, CA 90210-5027
Mailing address
435 N Roxbury Dr
Ste 100
Beverly Hills, CA 90210-5027
Phone (310) 855-8058
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 124156 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338768000000",
"number": "1174884456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "435 N ROXBURY DR",
"address_2": "STE 100",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902105027",
"telephone_number": "310-855-8058",
"fax_number": "310-855-8059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 N ROXBURY DR",
"address_2": "STE 100",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902105027",
"telephone_number": "310-855-8058",
"fax_number": "310-855-8059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LARRY",
"middle_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-04",
"last_updated": "2012-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "CA",
"license": "124156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beverly Hills, CA
- City of Beverly Hills (City of Beverly Hills Fire Department)
- City View Surgery Center, LLC.
- CL Global Logistics LLC
- Clarion Vision Corporation
- April Clark, PMHNP-BC
- Kimberly Estelle Clayborn, LICENSED MARRIAGE &
- Damaris D. Clement, MFT, PSY D
- Clifford J Merlo MD a Medical Corp
- CMR Rehab Center of Beverly Hills, LLC
- Crystal Marie Coatney, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.