DR. PAUL RAY CLARK M.D. NPI 1619362597

NPI Information

  • NPI: 1619362597
  • Provider Name: DR. PAUL RAY CLARK, M.D.
  • Classification: Surgery - 2086S0122X
  • Specialization: Plastic and Reconstructive Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 11515 EL CAMINO REAL STE 150
    SAN DIEGO, CA
    ZIP 92130
  • Phone: (858) 720-1440

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NPI Details

DR. Paul Ray Clark, M.D. is a plastic and reconstructive surgery surgery in San Diego, CA. The provider is a surgeon who specializes in plastic and reconstructive surgery. DR. Paul Ray Clark, M.D. NPI is 1619362597. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

11515 EL CAMINO REAL STE 150
SAN DIEGO, CA
ZIP 92130-037
Phone: (858) 720-1440

The NPI 1619362597 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/30/2015 and was last updated on 3/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0122XSurgeryPlastic and Reconstructive SurgeryA18267CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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