Provider Demographics
NPI:1548826860
Name:CLARK, CATHERINE TAGULAO
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TAGULAO
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 COBBLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5373
Mailing Address - Country:US
Mailing Address - Phone:661-397-0885
Mailing Address - Fax:661-855-4409
Practice Address - Street 1:9320 COBBLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-5373
Practice Address - Country:US
Practice Address - Phone:661-397-0885
Practice Address - Fax:661-855-4409
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157208832253Z00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility