Provider Demographics
NPI:1871849190
Name:RICHARDSON, CLINTON JEROME
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:JEROME
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 VIEW POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-5590
Mailing Address - Country:US
Mailing Address - Phone:956-221-0839
Mailing Address - Fax:
Practice Address - Street 1:3612 VIEW POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5590
Practice Address - Country:US
Practice Address - Phone:956-221-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04159504133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education