Provider Demographics
NPI:1083494843
Name:CLANTON, MARILYN DENISE
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:DENISE
Last Name:CLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W 92ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3627
Mailing Address - Country:US
Mailing Address - Phone:323-451-3469
Mailing Address - Fax:323-451-3469
Practice Address - Street 1:1440 W 92ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3627
Practice Address - Country:US
Practice Address - Phone:323-451-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide