Camellia P Clark MD Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

CAMELLIA P CLARK MD INC

Practice address

11515 El Camino Real
Suite #100
San Diego, CA 92130

Phone

(858) 263-5947

NPI assigned

May 1, 2024

Organization subpart

No

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

Authorized official

Name

Camellia ClarkNPI 1174624399

Title

Owner

Phone

(858) 263-5947

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Camellia P. Clark, M.D.

  • Psychiatry Physician
  • San Diego, CA
  • NPI 1174624399
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1689421471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 KEARNY MESA RD STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113771",
            "telephone_number": "858-263-5947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11515 EL CAMINO REAL",
            "address_2": "SUITE #100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92130",
            "telephone_number": "858-263-5947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELLIA P CLARK MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CAMELLIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-263-5947"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Evelyn Camarillo
• Evelyn Camba, RN
• Alfonso Camberos, M.D., F.A.C.S.
• Michelle Cambi
• Adriana Carolina Camelio, DACM
• Camen Optometry PC
• Margie A Camerino, PA-C
• Angela Cameron
• Christopher Anthony Cameron
• Delila Cameron

• Psychiatry Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.