Healthcare Provider Details

I. General information

NPI: 1720728199
Provider Name (Legal Business Name): ANDREW WILLIAM CLEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

8517 OAK AVE UNIT B
ORANGEVALE CA
95662-2332
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-2752
  • Fax:
Mailing address:
  • Phone: 206-557-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number60279027
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: