Provider Demographics
NPI:1730996968
Name:CLEMENTE, ASHLEY JAN TAN
Entity type:Individual
Prefix:DR
First Name:ASHLEY JAN
Middle Name:TAN
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4943 N PERSHING AVE APT 322
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6146
Mailing Address - Country:US
Mailing Address - Phone:650-867-0052
Mailing Address - Fax:
Practice Address - Street 1:4943 N PERSHING AVE APT 322
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6146
Practice Address - Country:US
Practice Address - Phone:650-867-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist