Healthcare Provider Details

I. General information

NPI: 1023220167
Provider Name (Legal Business Name): DANIEL JOSEPH MCCLOUGH P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 PEACH ST
CORNING CA
96021-3355
US

IV. Provider business mailing address

4597 COUNTY RD FF
ORLAND CA
95963
US

V. Phone/Fax

Practice location:
  • Phone: 530-690-2827
  • Fax: 784-168-1989
Mailing address:
  • Phone: 530-865-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: