Charisma Marie Clark, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN209103 Issued in CA

Practice address

4281 Katella Ave Ste 120
Los Alamitos, CA 90720-3592

Phone

(714) 503-6850

NPI assigned

Jul 12, 2012

Sex

Female

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

State licenses

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1205191475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4281 KATELLA AVE STE 120",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203592",
            "telephone_number": "714-503-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4281 KATELLA AVE STE 120",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203592",
            "telephone_number": "714-503-6850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARISMA",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN209103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra A Chrysanthis, MD
• Cecilia Chu, M.D.
• Chloe Chuang
• Christine J Chung, D.M.D.
• Winston Chung, MD
• Timothy Lee Clarke
• Claudia M Torres Therapy, a Prof Marriage & Family Counseling Corp
• Christopher Gray Cleary, DNP, PMHNP-BC
• Phillip Cleaver, LMFT
• Coast Internal Medical Associates

• Licensed Vocational Nurse in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.