Clelia Alexandra Clark, MD
Emergency Medicine in Santa Rosa, CA. Individual provider (NPI-1).
NPI number1295294163
StatusActive
Last updated in NPPESAug 3, 2022
Details
- NPI
- 1295294163
- Entity type
- Individual (NPI-1)
- Name
- Clelia Alexandra Clark
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 19, 2019
- Certification date
- Aug 3, 2022
- Last updated
- Aug 3, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - EMERGENCY MEDICINE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | A176361 | CA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1165 Montgomery DrSanta Rosa, CA 95405-4801
Phone 707-525-5300
Mailing address
2315 Stockton BlvdSacramento, CA 95817-2201
Phone 916-734-5010 · Fax 916-734-7950
Other practice locations
2315 Stockton Blvd
Sacramento, CA 95817-2201
Sacramento, CA 95817-2201
Phone 916-734-5010 · Fax 916-734-7950
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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