Provider Demographics
NPI:1871958736
Name:CLAMONTE, ROD SANTIAGO JR
Entity type:Individual
Prefix:MR
First Name:ROD
Middle Name:SANTIAGO
Last Name:CLAMONTE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RODANIM
Other - Middle Name:SANTIAGO
Other - Last Name:CLAMONTE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10007 SAINT ALBANS AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2014
Practice Address - Country:US
Practice Address - Phone:661-395-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-19
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily