Individual provider · NPI-1
Judson Clark
Registered Nurse, Psych/Mental Health, Adult · Mountain View, CA
NPI number1174126965
StatusActive
Last updated in NPPESNov 16, 2020
Details
- NPI
- 1174126965
- Entity type
- Individual (NPI-1)
- Name
- Judson Clark
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 16, 2020
- Certification date
- Nov 16, 2020
- Last updated
- Nov 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WP0809X | Registered Nurse, Psych/Mental Health, Adult | 769882 | CA | Yes |
Practice location
2500 Hospital Dr Bldg 3Mountain View, CA 94040-4106
Phone 650-863-9000
Mailing address
14245 W Park AveBoulder Creek, CA 95006-9304
Phone 408-571-8439
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