Provider Demographics
NPI:1275297301
Name:CLAVE, DENNIS C
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:CLAVE
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 1:182 SHADYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9185
Mailing Address - Country:US
Mailing Address - Phone:408-393-5158
Mailing Address - Fax:
Practice Address - Street 1:182 SHADYWOOD AVE
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-9185
Practice Address - Country:US
Practice Address - Phone:408-393-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9521528163W00000X
CA95251528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF8547039OtherKAIZER