Most Relevant Information
Provider Data
| NPI Number: | 1003482563 |
| Provider Name: | LAQUIESHA TANIESHA CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/03/2021 |
| Last Updated: | 06/03/2021 |
Provider Practice Location
6666 GREEN VALLEY CIR
CULVER CITY
CA
902307068
Practice Location Phone/Fax
| Phone: | 3108465270 |
| Fax: |
Provider Mailing Location
6666 GREEN VALLEY CIR
CULVER CITY
CA
902307068
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |