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General NPI Number Information
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NPI Number | 1801144944
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Entity Type | Organization
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Legal Business Name | CLARENCE M. HYSHAW M.D., INC.
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 928 CENTINELA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-1502
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Country | US
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Telephone | 310-673-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 928 CENTINELA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-1502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CLARENCE HYSHAW
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Credential | M.D.
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Telephone | 310-673-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A26220
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License Number State | CA
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