Provider Demographics
NPI:1730810177
Name:CLEMON, BILL CLEMON JOSEPH X
Entity type:Individual
Prefix:
First Name:BILL CLEMON
Middle Name:JOSEPH
Last Name:CLEMON
Suffix:X
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 1:1274 S WATERMAN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2844
Mailing Address - Country:US
Mailing Address - Phone:909-659-6255
Mailing Address - Fax:
Practice Address - Street 1:4150 LATHAM ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1735
Practice Address - Country:US
Practice Address - Phone:949-688-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician