Khristian Clark

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

25143 Jack Rabbit Acres
Escondido, CA 92026-1267

Phone

(760) 566-8648

NPI assigned

Oct 27, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1851055792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1738 S TREMONT ST",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920545309",
            "telephone_number": "760-439-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25143 JACK RABBIT ACRES",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920261267",
            "telephone_number": "760-566-8648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-27",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Escondido
• Jenae Ciuffreda, CSOM, CBBA
• Branislav Cizmar, MD
• Cjmbs Pharmacies Inc
• Lindsay Clare
• Michelle Clark
• Samantha Clark
• Shanna La Rhonda Clark
• Tyler Clark, BCBA
• Ummi Clark, CMT, CLC, CSC

• Rehabilitation Practitioner in Escondido, CA
• Providers in Escondido, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; 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.