Provider Demographics
NPI:1841740578
Name:CLEGG, NP CORP
Entity Type:Organization
Organization Name:CLEGG, NP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:310-339-7426
Mailing Address - Street 1:5042 WILSHIRE BLVD
Mailing Address - Street 2:562
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4305
Mailing Address - Country:US
Mailing Address - Phone:310-339-7426
Mailing Address - Fax:
Practice Address - Street 1:5042 WILSHIRE BLVD
Practice Address - Street 2:562
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4305
Practice Address - Country:US
Practice Address - Phone:310-339-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty