Healthcare Provider Details

I. General information

NPI: 1386657948
Provider Name (Legal Business Name): ERIC MCCLOUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST STE 315
VAN NUYS CA
91405-3616
US

IV. Provider business mailing address

23560 MADISON ST STE 206
TORRANCE CA
90505-4708
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-8080
  • Fax: 818-920-9957
Mailing address:
  • Phone: 310-325-1229
  • Fax: 310-325-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG61054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG61054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: