Active NPI
Quinnita Christine Clark
- Case Manager/Care Coordinator
- San Bernardino, CA
National Provider Identifier
1861692212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 700 E Gilbert St BLDG 4
San Bernardino, CA 92415-1003 - Phone
- (909) 387-7194
- Fax
- (909) 387-7100
- NPI assigned
- Jul 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
700 E Gilbert St BLDG 4
San Bernardino, CA 92415-1003
Mailing address
700 E Gilbert St BLDG 4
San Bernardino, CA 92415-1003
Phone (909) 387-7194
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000 | Other | CA | MENTAL HEALTH SERVICE ACT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185235200000",
"number": "1861692212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 E GILBERT ST BLDG 4",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924151003",
"telephone_number": "909-387-7194",
"fax_number": "909-387-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 E GILBERT ST BLDG 4",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924151003",
"telephone_number": "909-387-7194",
"fax_number": "909-387-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "QUINNITA",
"middle_name": "CHRISTINE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-24",
"last_updated": "2007-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MENTAL HEALTH SERVICE ACT",
"identifier": "0000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.