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NPI Code Detail

MEDICARE: ASHLEY MARIE CLEMONS RD

MEDICARE: ASHLEY MARIE CLEMONS RD
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
1133V00000XRegistered Dietitian86211290CA

General Provider Information

NPI Number : 1801738166
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY MARIE CLEMONS RD
Provider Business Mailing Address
First Line : 1200 B GALE WILSON BLVD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-3552
Country : US
Telephone Number : 707-646-5355
Fax Number :
Provider Business Practice Location Address
First Line : 1200 B GALE WILSON BLVD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-3552
Country : US
Telephone Number : 707-646-5355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ ASHLEY MARIE CLEMONS RD” Practice Location

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