Individual
AUTUM RAE CLEMENTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4295 BROCKTON AVE, RIVERSIDE, CA 92501-3446
(951) 341-3786
Mailing address
5870 ARLINGTON AVE, RIVERSIDE, CA 92504-2037
(951) 683-6596
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487716619
—
CA
Enumeration date
12/15/2021
Last updated
02/08/2023
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