Healthcare Provider Details

I. General information

NPI: 1912367814
Provider Name (Legal Business Name): CLINTON JOSEPH BORN NP, RN, PHRN, EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45930 DAVIANA WAY
TEMECULA CA
92592-4170
US

IV. Provider business mailing address

83 SANDRA CT
PORTERVILLE CA
93257-1690
US

V. Phone/Fax

Practice location:
  • Phone: 815-275-2488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number800956
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95020099
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP31593
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number800956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: