Provider Demographics
NPI:1891983748
Name:BULLOCK, CLAYTON MATTHEW (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:MATTHEW
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 N POINSETTIA PL APT 7
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5797
Mailing Address - Country:US
Mailing Address - Phone:323-632-8144
Mailing Address - Fax:323-632-8144
Practice Address - Street 1:1152 N POINSETTIA PLACE #7
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046
Practice Address - Country:US
Practice Address - Phone:323-632-8144
Practice Address - Fax:323-632-8144
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA946412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry