Provider Demographics
NPI:1245333442
Name:CLOTHIER, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CLOTHIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 SIERRA VISTA LN
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9588
Mailing Address - Country:US
Mailing Address - Phone:530-878-4586
Mailing Address - Fax:
Practice Address - Street 1:3200 BELL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9244
Practice Address - Country:US
Practice Address - Phone:530-888-7616
Practice Address - Fax:530-886-5947
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F80323Medicare UPIN