Provider Demographics
NPI:1205093580
Name:WRIGLEY, CLINTON (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:
Last Name:WRIGLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 UTAH AVE
Mailing Address - Street 2:RADIOLOGY PARTNERS
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245
Mailing Address - Country:US
Mailing Address - Phone:424-290-8004
Mailing Address - Fax:
Practice Address - Street 1:2330 UTAH AVE
Practice Address - Street 2:RADIOLOGY PARTNERS
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:242-908-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1244872085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015212700Medicaid
FLIH880XMedicare PIN
FL015212700Medicaid
FLIH880ZMedicare PIN