MEDICARE: MS. LORI MCCLAIN PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95019695	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ICAN866	OTHER	CA	LA COUNTY DMH

General Provider Information

NPI Number	:	1720312606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI MCCLAIN PMHNP

Provider Business Mailing Address
First Line	:	12215 TELEGRAPH RD STE 107
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Provider Business Practice Location Address
First Line	:	12215 TELEGRAPH RD STE 107
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	02/17/2025

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