Provider Demographics
NPI:1326340563
Name:MC FADDEN, CLARENCE GARLAND
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:GARLAND
Last Name:MC FADDEN
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 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:SUITE 424
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:562-208-8261
Mailing Address - Fax:
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:SUITE 424
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:562-208-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator