MEDICARE: CLARION TECHNOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
2	174400000X	Specialist

General Provider Information

NPI Number	:	1144740739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARION TECHNOLOGY LLC

Provider Business Mailing Address
First Line	:	4441 AUBURN BLVD STE J
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4139
Country	:	US
Telephone Number	:	916-550-1050
Fax Number	:	916-550-1238

Provider Business Practice Location Address
First Line	:	5000 ATRIUM WAY STE 3
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3915
Country	:	US
Telephone Number	:	916-550-1050
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MS. DEANE' WALLACE
Credential	:
Telephone Number	:	916-571-9041

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	07/18/2017

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