Individual provider · Type 1 NPI

Christina Marie Clack, PNP (C)

Pediatric Nurse Practitioner · Los Angeles, CA

NPI number 1699365601 Active

Practice location

808 W 58th St
Los Angeles, CA 90037-3632

Call (323) 541-1600 Map

Mailing address

3153 Rollings Ave
Thousand Oaks, CA 91360-6433

Other practice locations

  • 2601 E Main St Ste 200, Ventura, CA 93003-2801 · (805) 643-7500

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200X95015295 (CA)
Nurse Practitioner 363L00000X95015295 (CA)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1699365601

Christina Marie Clack, PNP (C)'s National Provider Identifier is 1699365601, issued on Jan 23, 2021. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Los Angeles, CA. The record was last updated on Jul 17, 2025.