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

Tatianna Clark

Individual provider Medical Physician Assistant · NPI 1104692144

Tatianna Clark is a Medical Physician Assistant in Riverside, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2023

Practice location Address checks out

3940 Polk St Unit A
Riverside, CA 92505-1998
Phone: (818) 632-4265
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 63689 (CA)

Record details

NPI number1104692144
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 30, 2023
Last updated in NPPESNovember 30, 2023
Certification dateNovember 30, 2023
Mailing address3940 Polk St Unit A, Riverside, CA 92505-1998

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