Provider Demographics
NPI:1295524346
Name:MCCLAIN, GENESEE AQUILA
Entity type:Individual
Prefix:MS
First Name:GENESEE
Middle Name:AQUILA
Last Name:MCCLAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 CORDOVA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3007
Mailing Address - Country:US
Mailing Address - Phone:626-808-3974
Mailing Address - Fax:
Practice Address - Street 1:1136 CORDOVA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3007
Practice Address - Country:US
Practice Address - Phone:626-808-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program