Provider Demographics
NPI:1942327275
Name:WOOLLEY, CLAYTON (LAC)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SO. FREEMAN ST..
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054
Mailing Address - Country:US
Mailing Address - Phone:760-331-3644
Mailing Address - Fax:
Practice Address - Street 1:2231 S EL CAMINO REAL STE A
Practice Address - Street 2:SUITE 105
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5775
Practice Address - Country:US
Practice Address - Phone:760-331-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6138171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist