Desiree Imani Clark

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

3186 Airway Ave Ste a
Costa Mesa, CA 92626-4650

Phone

(714) 881-0427

NPI assigned

Sep 25, 2019

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1750932349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 OLD OAK DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921146027",
            "telephone_number": "619-962-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3186 AIRWAY AVE STE A",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264650",
            "telephone_number": "714-881-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DESIREE",
        "middle_name": "IMANI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "healthy.kaiserpermanente.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "San Diego",
            "address_1": "4405 Vandever Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921203315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• City of Costa Mesa
• City of Costa Mesa Finance Dept (Costa Mesa Fire and Rescue)
• Joshua Claramunt, M.S.
• Clarity Home Care Inc.
• Craig Raymond Clark, DC
• Kimberly Irene Clark, MFT
• Konner Steven Clarson
• Claudio M. Carvalho, D.O, a Professional Medical Corporation (Functional Orthopedic Rehabilitation Medicine Associates)
• Clean & Sober Living Corp
• Clean Path Recovery, LLC (Clean Path Behavioral Health)

• Behavior Analyst in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.