Provider Demographics
NPI:1700300829
Name:MCCLURE, TRUDY LOUISE
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:LOUISE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23217
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-3217
Mailing Address - Country:US
Mailing Address - Phone:760-754-5946
Mailing Address - Fax:760-754-5954
Practice Address - Street 1:1305 UNION PLAZA CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3496
Practice Address - Country:US
Practice Address - Phone:760-754-5946
Practice Address - Fax:760-754-5954
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator