Individual
ETHEL GONZALES CLEMENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3525 PELANDALE AVE, MODESTO, CA 95356-9781
(559) 572-3880
Mailing address
9300 VALLEY CHILDRENS PL # SC05, MADERA, CA 93636-8761
(559) 353-5700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
098965
OH
2080P0205X
Pediatric Endocrinology Physician
23711
MS
2080P0205X
Pediatric Endocrinology Physician
4301114264
MI
2080P0205X
Pediatric Endocrinology Physician
Primary
C175083
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497986731
—
CA
Enumeration date
08/04/2009
Last updated
03/08/2022
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