Isaiah Daniel Clark

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

License

1066261 Issued in CA

Practice address

19510 Van Buren Blvd # F3-1045
Riverside, CA 92508-9457

Phone

(951) 215-6829

Fax

(951) 246-0734

NPI assigned

Oct 31, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1604102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1861092447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22376 N MULLIGAN DR",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851382353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19510 VAN BUREN BLVD # F3-1045",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925089457",
            "telephone_number": "951-215-6829",
            "fax_number": "951-246-0734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ISAIAH",
        "middle_name": "DANIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-31",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Exercise Physiologist",
            "state": "CA",
            "license": "1066261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN COLLEGE OF SPORTS MEDICINE",
            "identifier": "872340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandi Clark
• Chad Leroy Clark, M.D.
• Craig Anson Clark, PA-C
• Danielle Clark
• Gary Michael Jesus Clark, CHW
• Jaclyn Clark
• Jacorey Clark
• John Patrick Clark
• Kasimira Clark, CCC-SLP
• Keely Marie Clark

• Clinical Exercise Physiologist in Riverside, CA
• Providers in Riverside, CA by specialty
• Clinical Exercise Physiologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; 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.