Provider Demographics
NPI:1336123116
Name:MACCLAIN, TONI (NP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:MACCLAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CASA ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1818
Mailing Address - Country:US
Mailing Address - Phone:805-595-1808
Mailing Address - Fax:805-595-1815
Practice Address - Street 1:35 CASA ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1818
Practice Address - Country:US
Practice Address - Phone:805-595-1808
Practice Address - Fax:805-595-1815
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5592363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009572Medicaid
NH30009572Medicaid
NP0910Medicare ID - Type Unspecified