Healthcare Provider Details

I. General information

NPI: 1073406013
Provider Name (Legal Business Name): DEAN E MCCLEVE CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 MESQUITE AVE # B
LAKE HAVASU CITY AZ
86403-5729
US

IV. Provider business mailing address

1976 MESQUITE AVE # B
LAKE HAVASU CITY AZ
86403-5729
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-6530
  • Fax: 480-242-6530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02666
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02666
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: