Provider Demographics
NPI:1770576951
Name:CLAYTON, VIVIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 BUENA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2019
Mailing Address - Country:US
Mailing Address - Phone:510-548-5215
Mailing Address - Fax:510-849-4188
Practice Address - Street 1:15 ALTARINDA RD
Practice Address - Street 2:SUITE 212
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2607
Practice Address - Country:US
Practice Address - Phone:925-258-9928
Practice Address - Fax:925-258-9173
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL79650Medicare ID - Type Unspecified