Healthcare Provider Details

I. General information

NPI: 1144740739
Provider Name (Legal Business Name): CLARION TECHNOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ATRIUM WAY STE 3
MOUNT LAUREL NJ
08054-3915
US

IV. Provider business mailing address

4441 AUBURN BLVD STE J
SACRAMENTO CA
95841-4139
US

V. Phone/Fax

Practice location:
  • Phone: 916-550-1050
  • Fax:
Mailing address:
  • Phone: 916-550-1050
  • Fax: 916-550-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEANE' WALLACE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 916-571-9041