1588438287 NPI number — LILLIAN VALE CLARK PHD

Table of content: LILLIAN VALE CLARK PHD (NPI 1588438287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588438287 NPI number — LILLIAN VALE CLARK PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK
Provider First Name:
LILLIAN
Provider Middle Name:
VALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENDERSON
Provider Other First Name:
LILLIAN
Provider Other Middle Name:
VALE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588438287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BUILDING 599 UNIVERSITY OF CALIFORNIA SANTA BARBARA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93106-3979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-724-0449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UC SANTA BARBARA CAPS BUILDING 599
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93106-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-893-4411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  PSY34609 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)