Provider Demographics
NPI:1225540461
Name:POLINES, CLEMENTE
Entity Type:Individual
Prefix:
First Name:CLEMENTE
Middle Name:
Last Name:POLINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 STONERIDGE DR STE 207
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8592
Mailing Address - Country:US
Mailing Address - Phone:925-520-0005
Mailing Address - Fax:
Practice Address - Street 1:1700 BROADWAY STE 500
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2141
Practice Address - Country:US
Practice Address - Phone:510-273-4200
Practice Address - Fax:510-273-8340
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor