Provider Information for 1508454745
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CHANTEL R CLARKE
Sex: Female
NPI: 1508454745
Last Updated: 2021-01-04
Certification Date: 2021-01-04
Certification Date: 2021-01-04
Details
Name | Value | ||||||||
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NPI | 1508454745 | ||||||||
Enumeration Date | 2021-01-04 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 7601 GATEWAY BLVD APT 1536 LIVE OAK, TX 78233-2769 United States Phone: 210-723-5647 | Fax: | ||||||||
Primary Practice Address | 300 E RAMSEY RD STE 305 SAN ANTONIO, TX 78216-3932 United States Phone: 210-723-5647 | Fax: | ||||||||
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