1396813887 NPI number — ELISE CLOTHEY HARRINGTON DC

Table of content: ELISE CLOTHEY HARRINGTON DC (NPI 1396813887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396813887 NPI number — ELISE CLOTHEY HARRINGTON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLOTHEY HARRINGTON
Provider First Name:
ELISE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLOTHEY
Provider Other First Name:
ELISE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396813887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91979-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-980-2288
Provider Business Mailing Address Fax Number:
619-463-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8680 NAVAJO RD
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-980-2288
Provider Business Practice Location Address Fax Number:
619-460-7267
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC17066 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 17066 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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