Basic Information
| Provider Information | |||||||||
| NPI: | 1245333442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLOTHIER | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2791 SIERRA VISTA LN | ||||||||
| Address2: | |||||||||
| City: | MEADOW VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957229588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308784586 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 BELL RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956039244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308887616 | ||||||||
| FaxNumber: | 5308865947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G85710 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.