Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Clelia Alexandra Clark, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1295294163

Clelia Alexandra Clark, MD is an Emergency Medicine in Santa Rosa, California. Graduated from University of California, Irvine, California College of Medicine in 2019, 7 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
7
Trained at
University of California, Irvine, California College of Medicine
Licensed in
CA
In the registry since
2019
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone: (707) 525-5300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2315 Stockton Blvd, Sacramento, CA 95817-2201 — (916) 734-5010

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence A176361 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1295294163
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 19, 2019
Last updated in NPPESAugust 3, 2022
Certification dateAugust 3, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolUNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Graduated 2019 (7 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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