Healthcare Provider Details

I. General information

NPI: 1922935832
Provider Name (Legal Business Name): CLAYTON SUTTLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 133
OAKLAND CA
94605-2480
US

IV. Provider business mailing address

529 BUENA VISTA AVE APT 204
ALAMEDA CA
94501-2042
US

V. Phone/Fax

Practice location:
  • Phone: 510-337-7950
  • Fax:
Mailing address:
  • Phone: 818-912-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: