Healthcare Provider Details

I. General information

NPI: 1073723433
Provider Name (Legal Business Name): CLYDE T ARNOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR SUITE 512
LOS ANGELES CA
90008-3606
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR SUITE 512
LOS ANGELES CA
90008-3606
US

V. Phone/Fax

Practice location:
  • Phone: 323-291-6432
  • Fax:
Mailing address:
  • Phone: 323-291-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA22479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: