Basic Information
| Provider Information | |||||||||
| NPI: | 1770050387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARKSON | ||||||||
| FirstName: | IAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40982 BANKHALL ST | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925321641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512028474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4867 W SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900275969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237834011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2279P3900X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Neonatal/Pediatrics |
No ID Information.