Individual ProviderPatricia Chu ClarkPediatricsAllopathic & Osteopathic PhysiciansPractice Address8110 Birmingham Way, San Diego, CA 92123-2758(858) 966-4032(858) 309-6303PECOS EnrollmentBased on the most recent information from CMS, provider Patricia Chu Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:29 PM.Profile DetailsProvider ID1982776506Provider TypeIndividualFull NameClark, Patricia ChuCredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date11/15/2006Last Updated8/25/2011Contact InformationPractice LocationPractice Address8110 Birmingham Way, San Diego, CA 92123-2758Phone(858) 966-4032FaxUnlisted FaxMailing LocationMailing Address3860 Calle Fortunada, Suite 210, San Diego, CA 92123-4800Phone(858) 309-6303Fax(858) 309-6301Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseG16640CaliforniaProvider IdentifiersIDDescriptionIssuerID00G166400DescriptionMedicaidIssuerUnlistedCalifornia