Provider Demographics
NPI:1619710530
Name:MCCARTY, CLANCY (CNM, RN)
Entity type:Individual
Prefix:
First Name:CLANCY
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 SILVERWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1447
Mailing Address - Country:US
Mailing Address - Phone:310-780-1094
Mailing Address - Fax:
Practice Address - Street 1:1416 EL CENTRO ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3202
Practice Address - Country:US
Practice Address - Phone:626-399-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95224570163WM0102X
CA236456367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn