Basic Information
| Provider Information | |||||||||
| NPI: | 1831428028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STARK | ||||||||
| FirstName: | CLAUDENE | ||||||||
| MiddleName: | KOROS | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 BAKER STREET | ||||||||
| Address2: | MINUTE CLINIC | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146627517 | ||||||||
| FaxNumber: | 9497221750 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 BAKER STREET | ||||||||
| Address2: | MINUTE CLINIC | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146627517 | ||||||||
| FaxNumber: | 9497221750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A45158 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 19532 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.