Basic Information
| Provider Information | |||||||||
| NPI: | 1588670509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLAIN | ||||||||
| FirstName: | JANIS | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4133 VISTA WAY | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956164330 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167335336 | ||||||||
| FaxNumber: | 9167335385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207N00000X | G44769 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 000810342691 | 01 | CA | PHCS | OTHER | MCMG170000 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 12570 | 01 | CA | INTERPLAN | OTHER | 3737356 | 01 | CA | CIGNA | OTHER | 4509119 | 01 | CA | AETNA | OTHER | 1062658 | 01 | CA | FIRST HEALTH | OTHER | G44769 | 01 | CA | BLUE CROSS | OTHER | 011100 | 01 | CA | HEALTH NET | OTHER | 1454467 | 01 | CA | UNITED HEALTHCARE | OTHER | 90026465 | 01 | CA | PACIFICARE | OTHER |