Provider Demographics
NPI:1508554536
Name:DAVID, CLAY PAUL
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:PAUL
Last Name:DAVID
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 1:819 CRAGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1303
Mailing Address - Country:US
Mailing Address - Phone:510-507-4751
Mailing Address - Fax:
Practice Address - Street 1:1160 BRICKYARD COVE RD STE 111
Practice Address - Street 2:
Practice Address - City:POINT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4112
Practice Address - Country:US
Practice Address - Phone:925-334-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program