Provider Demographics
NPI:1255687075
Name:SCULLION, CLIVE (CMP)
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:
Last Name:SCULLION
Suffix:
Gender:M
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 HARBORD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2207
Mailing Address - Country:US
Mailing Address - Phone:510-540-8200
Mailing Address - Fax:
Practice Address - Street 1:4400 HARBORD DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-2207
Practice Address - Country:US
Practice Address - Phone:510-540-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies