Basic Information
| Provider Information | |||||||||
| NPI: | 1487674701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AU | ||||||||
| FirstName: | CLEMENT | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78120 WILDCAT DR | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922111140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603402682 | ||||||||
| FaxNumber: | 7607739695 | ||||||||
| Practice Location | |||||||||
| Address1: | 78120 WILDCAT DR | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922111140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603402682 | ||||||||
| FaxNumber: | 7607739695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G88893 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.