Healthcare Provider Details

I. General information

NPI: 1144534660
Provider Name (Legal Business Name): RANDY CLAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ARROWOOD DR
SANTA ROSA CA
95407-7503
US

IV. Provider business mailing address

440 ARROWOOD DR
SANTA ROSA CA
95407-7503
US

V. Phone/Fax

Practice location:
  • Phone: 707-970-8752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: