Provider Demographics
NPI:1982992483
Name:STARNER, CLOTILE (NCTMB, CMT)
Entity Type:Individual
Prefix:
First Name:CLOTILE
Middle Name:
Last Name:STARNER
Suffix:
Gender:F
Credentials:NCTMB, CMT
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 55783
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-0783
Mailing Address - Country:US
Mailing Address - Phone:510-782-7637
Mailing Address - Fax:510-733-9173
Practice Address - Street 1:3319 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5601
Practice Address - Country:US
Practice Address - Phone:510-782-7637
Practice Address - Fax:510-733-9173
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator