ANTHONY CLARK (NPI# 1902211634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902211634 |
| Entity Type | Individual |
| Full Name | ANTHONY CLARK |
| Practice Address |
2424 Rendova Rd San Diego CA 92155-5041 |
| Mailing Address |
2931 Gabrielson Ave San Diego CA 92111-5814 |
| Practice Telephone | 6195373941 |
| Mailing Telephone | 7604017807 |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174026298 | Anthony Jamal Clark | Occupational Therapist | 2301 Montgomery Dr W, Wilson, NC 27893-4476 | 2018-03-15 |
| 1962537142 | Anthony Clark | Rehabilitation Practitioner | 7445 Hellman Ave, Rancho Cucamonga, CA 91730-1304 | 2007-02-21 |
| 1467931352 | Anthony Clark | Dentist | 4129 S Mooney Blvd Ste B, Visalia, CA 93277-9147 | 2018-08-10 |
| 1033614250 | Anthony Michael Clark | Student in an Organized Health Care Education/Training Program | 530 S Jackson St, Louisville, KY 40202-1675 | 2018-03-28 |
| 1598294746 | Anthony Martin Clark II | Counselor | 8946 Interline Ave Ste A, Baton Rouge, LA 70809-1913 | 2017-06-09 |
| 1164806055 | Anthony Clark | Dentist | 733 Oakwood Dr, Fenton, MO 63026-3535 | 2015-07-10 |
| 1841679057 | Anthony Ivins Clark | Student in an Organized Health Care Education/Training Program | 1356 Lusitana St, 7th Floor, Honolulu, HI 96813-2409 | 2015-05-20 |
| 1477754976 | Anthony Jose Clark | Pathology | 1899 Eider Ct, Kwb Pathology Assoc. District 2 O.m.e, Tallahassee, FL 32308-4537 | 2007-05-30 |
| 1174644421 | Anthony Rhoden Clark | Dentist | 3707 Chamberlain Ln, Suitte 103, Louisville, KY 40241-2001 | 2007-04-03 |
| 1366590549 | Anthony W. Clark | Counselor | 252 W Swamp Rd, Suite 56, Doylestown, PA 18901-2422 | 2007-01-06 |
| Street Address |
2424 RENDOVA RD |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92155-5041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790756682 | Ahmik Lytton Jones | Preventive Medicine | 2424 Rendova Rd, San Diego, CA 92155-5401 | 2006-01-30 |
| 1801201462 | Robert Allen Hooffstetter | Military Health Care Provider | 2424 Rendova Rd, Suite 156, San Diego, CA 92155-5041 | 2014-06-23 |
| 1487099008 | Carlos J Gomez | Military Health Care Provider | 2424 Rendova Rd, Bldg 156, San Diego, CA 92155-5041 | 2013-05-09 |
| 1427029933 | Robert Edward Obrecht | Clinical Neuropsychologist | 2424 Rendova Rd, Building 156, San Diego, CA 92155-5401 | 2006-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134454770 | Carrie Lynn Decker | Military Health Care Provider | Eod Exp Support Unit One, 3502 Attu Rd Bldg 326 San Diego Ca, Apo, AA 92155 | 2009-10-15 |
| 1578779559 | Joe Leonard Bonvie | Psychologist | Naval Special Warfare Command, Medical Dept Code 04, 2000 Trident Way, San Diego, CA 92155 | 2007-05-15 |
| 1134350226 | Christopher Robert Terry | Military Health Care Provider | 2446 Trident Way, Coranado, CA 92155 | 2009-08-06 |
| 1003840653 | Robert David Gerardi | Military Health Care Provider | 2841 Rendova Road, San Diego, CA 92155 | 2006-07-10 |
| 1346597234 | Jermy Joe Brower | Military Health Care Provider | Seal Team One 2534 Trident Way Bldg 614, San Diego, CA 92155-0001 | 2012-08-09 |
| 1720376684 | Brittany A Hout | Physician Assistant | Anaconda Rd Bldg 262, San Diego, CA 92155-0001 | 2011-07-13 |
| 1639278682 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Bouganville Rd, Bldg 506, San Diego, CA 92155-0001 | 2006-09-22 |
| 1902393176 | Benjamin Alexander Sebreros | Student in an Organized Health Care Education/Training Program | 2446 Trident Way Bldg 637, San Diego, CA 92155-0001 | 2018-04-13 |
| 1790056372 | U. S. Navy | Military Hospital | 3423 Guadalcanal Rd, Bldg 401 2nd Deck, San Diego, CA 92155-5000 | 2012-01-13 |
| 1366592248 | Robert Ray Lowe Jr. | Emergency Medicine | 3400 Tarawa Rd, San Diego, CA 92155-5002 | 2007-01-11 |
| Find all providers in zip 92155 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770180648 | Darius Lee Sean Woods | Military Health Care Provider | 6033 Sandy Shore Ct, San Diego, CA 92139-1014 | 2020-10-05 |
| 1174130744 | Daniel Carrera | Military Health Care Provider | 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 | 2020-09-28 |
| 1316551740 | Kyle Bode Francis | Military Health Care Provider | 3149 Murray Ridge Rd, San Diego, CA 92123-2917 | 2020-09-02 |
| 1255945069 | Jeremy Lee | Military Health Care Provider | 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 | 2020-08-31 |
| 1013520667 | Rashaad Brown | Military Health Care Provider | 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 | 2020-08-24 |
| 1932711934 | Alvaro Daniel Macias | Military Health Care Provider | 8685 Rio San Diego Dr Apt 4344, San Diego, CA 92108-6560 | 2020-08-20 |
| 1689286189 | Charles Luke Morris | Military Health Care Provider | 1675 Beta Ct, San Diego, CA 92126-7060 | 2020-08-18 |
| 1255943635 | Stephon Peyton Frost | Military Health Care Provider | 2654 Mendonca Dr, San Diego, CA 92110-4263 | 2020-08-18 |
| 1184235871 | Jaden Sandi | Military Health Care Provider | Swmi Sfidc Bldg 14 34101 Farenholt Ave, San Diego, CA 92134-0001 | 2020-08-14 |
| 1477178457 | Joseph Hunter Sampson | Military Health Care Provider | 34101 Farenholt Ave #14, San Diego, CA 92134 | 2020-06-15 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.