Healthcare Provider Details

I. General information

NPI: 1942255153
Provider Name (Legal Business Name): CLINTON PEARL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E ROMIE LN
SALINAS CA
93901-4029
US

IV. Provider business mailing address

PO BOX 2420
SALINAS CA
93902-2420
US

V. Phone/Fax

Practice location:
  • Phone: 831-759-1840
  • Fax:
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 146558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: