Provider Demographics
NPI:1184772055
Name:HARTMAN, CLIFFORD THOMAS JR (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:THOMAS
Last Name:HARTMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:THOMAS
Other - Last Name:HARTMAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1346 FOOTHILL BLVD., SUITE 301
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011
Mailing Address - Country:US
Mailing Address - Phone:818-790-1587
Mailing Address - Fax:818-952-3473
Practice Address - Street 1:1346 FOOTHILL BLVD., SUITE 301
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011
Practice Address - Country:US
Practice Address - Phone:818-790-1587
Practice Address - Fax:818-952-3473
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25306207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy