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Contact Information

GLENN A CLARK, CRNA
207 W LEGION RD
BRAWLEY, CA92227
 Phone: 760-351-3333
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Anesthetist, Certified Registered

367500000X 43 Certified Registered Nurse Anesthetist (CRNA)
Indicates primary specialty

NPI Profile & details for GLENN A CLARK · (Male)

NPI # 1568632982
Status Active
Credentials CRNA (Certified Registered Nurse Anesthetist)
Entity Individual
Enumeration date 03/03/2008
Last updated 02/08/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • CA License # NA3696
Hospital affiliation(s)
  • LOMA LINDA UNIVERSITY MEDICAL CENTER - (Acute Care)
    11234 ANDERSON ST
    LOMA LINDA, CA 92354
  • LOMA LINDA UNIVERSITY MEDICAL CENTER-MURRIETA - (Acute Care)
    28062 BAXTER ROAD
    MURRIETA, CA 92563
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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