Healthcare Provider Details

I. General information

NPI: 1770576951
Provider Name (Legal Business Name): VIVIAN CLAYTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ALTARINDA RD SUITE 212
ORINDA CA
94563-2607
US

IV. Provider business mailing address

3015 BUENA VISTA WAY
BERKELEY CA
94708-2019
US

V. Phone/Fax

Practice location:
  • Phone: 925-258-9928
  • Fax: 925-258-9173
Mailing address:
  • Phone: 510-548-5215
  • Fax: 510-849-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPSY7965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: