Clark Pediatrics and Family Medicine Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A18257 Issued in CA

Legal business name

CLARK PEDIATRICS AND FAMILY MEDICINE INC

Practice address

15 Mareblu
Suite 340
Aliso Viejo, CA 92656-3015

Phone

(949) 831-1466

Fax

(949) 831-1462

NPI assigned

Sep 3, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Heather Maile Tomlin

Title

Billing Manager

Phone

(949) 458-7736

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220400000000",
    "number": "1619125770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MAREBLU",
            "address_2": "SUITE 340",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563015",
            "telephone_number": "949-831-1466",
            "fax_number": "949-831-1462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MAREBLU",
            "address_2": "SUITE 340",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563015",
            "telephone_number": "949-831-1466",
            "fax_number": "949-831-1462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK PEDIATRICS AND FAMILY MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-03",
        "last_updated": "2008-09-03",
        "status": "A",
        "authorized_official_last_name": "TOMLIN",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "MAILE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "949-458-7736",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A18257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Aliso Viejo, CA
• Providers in Aliso Viejo, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; 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.