Provider Demographics
NPI:1417142209
Name:CLAYTON, MEREDITH I (DO)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:I
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LLU PREVENTIVE MEDICINE RESIDENCY PROGRAM
Mailing Address - Street 2:NICHOL HALL #1516
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-4918
Mailing Address - Fax:
Practice Address - Street 1:LLU PREVENTIVE MEDICINE RESIDENCY PROGRAM
Practice Address - Street 2:NICHOL HALL #1516
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 10004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics