Marisa Clarke

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN717771 Issued in CA

Practice address

801 E Chapman Ave
Fullerton, CA 92831-3839

Phone

(714) 680-8265

NPI assigned

Dec 3, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Marisa Tinajero Former name

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": "1228262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1811132905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21505 NORWALK BLVD",
            "city": "HAWAIIAN GARDENS",
            "state": "CA",
            "postal_code": "907161121",
            "telephone_number": "562-916-7581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E CHAPMAN AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928313839",
            "telephone_number": "714-680-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "MARISA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-03",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "225400000X",
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN717771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "TINAJERO",
            "credential": "LVN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Madison Mimi Clark
• Olivia Clark
• Tracey Clark, M.A., LMFT
• Clarke Lew Medical Corp
• Grant David Clarke, LCSW
• Sharray Marie Clarke
• Clarvida
• Ellianna Marie Maligaya Claudio
• Jordan Clay
• Hailey Rose Cleavenger

• Licensed Vocational Nurse in Fullerton, CA
• Providers in Fullerton, 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 Dec 29, 2021; 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.