Madeline Clark

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

686532 Issued in CA

Practice address

1950 E 17TH St Ste 150
Santa Ana, CA 92705-6852

Phone

(714) 547-5375

NPI assigned

Nov 10, 2020

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

State licenses

Interoperability endpoints

• Direct secure messaging: mclark@cornerstonesocal.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1881296465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 SILVER FIR RD",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917893216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E 17TH ST STE 150",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927056852",
            "telephone_number": "714-547-5375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MADELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "686532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mclark@cornerstonesocal.com",
            "affiliation": "N",
            "address_1": "1950 E 17th St Ste 150",
            "city": "Santa Ana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927056852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Steven Jefferson Clagett, MFT
• Clara Vista Optometry
• Jacklyn Susanne Clark
• Jameelah Aysa Clark
• Joan H Clark, RN
• Morgan Elizabeth Clark
• Nolan Clark
• Rachel Frances Clark, MS, MFT INTERN
• Ralph K Clark
• Crystal Clarke-Valencia, LCSW

• Licensed Vocational Nurse in Santa Ana, CA
• Providers in Santa Ana, 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 Nov 10, 2020; 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.