Jason Robert Clark

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1080 Marina Village Pkwy
Alameda, CA 94501-6427

Phone

(510) 418-5094

NPI assigned

Aug 11, 2025

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1386529907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29166 WOODBINE LN",
            "address_2": "CLARKJ83@HOTMAIL.COM",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925849258",
            "telephone_number": "951-897-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 MARINA VILLAGE PKWY",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945016427",
            "telephone_number": "510-418-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JASON",
        "middle_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Alameda
• City of Alameda Health Care District
• Jennifer Clara-Estrada
• Claremont Behavioral Services
• Janelle Veronica Clark
• Michelle Olivette Clark, M.D.
• William Blackmore Claussen, DDS
• Arthur Clinton
• Jennifer Nayeli Cloer
• Coast Guard Headquarters

• Student in an Organized Health Care Education/Training Program in Alameda, CA
• Providers in Alameda, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.