Provider Demographics
NPI:1164870820
Name:MCINNIS, CLAYTON (RN)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:
Last Name:MCINNIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2720
Mailing Address - Country:US
Mailing Address - Phone:818-472-3857
Mailing Address - Fax:
Practice Address - Street 1:6622 IRIS DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-2720
Practice Address - Country:US
Practice Address - Phone:818-472-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse