Provider Demographics
NPI:1487017224
Name:LAVALLEY, CLAYTON
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:LAVALLEY
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 1:4400 V ST
Mailing Address - Street 2:PATH BLDG
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1445
Mailing Address - Country:US
Mailing Address - Phone:916-734-2350
Mailing Address - Fax:916-734-6468
Practice Address - Street 1:4400 V ST
Practice Address - Street 2:PATH BLDG
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1445
Practice Address - Country:US
Practice Address - Phone:916-734-2350
Practice Address - Fax:916-734-6468
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173945207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology