Most Relevant Information
Provider Data
| NPI Number: | 1003386657 |
| Provider Name: | DMITRIUS CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/27/2018 |
| Last Updated: | 11/27/2018 |
Provider Practice Location
3620 W. HAMMER LANE
STOCKTON
CA
95219
Practice Location Phone/Fax
| Phone: | 2095214791 |
| Fax: |
Provider Mailing Location
3425 COFFEE RD SUITE C2
MODESTO
CA
95355
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |