Provider Demographics
NPI:1437207750
Name:CLAY, CORRIE TOLERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:TOLERICO
Last Name:CLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3134
Mailing Address - Country:US
Mailing Address - Phone:619-464-6434
Mailing Address - Fax:619-464-5109
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:619-464-6434
Practice Address - Fax:619-464-5109
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91977OtherSTATE MED BD LICENSE