Individual
DR. AUTUMN PATRICIA CLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
33353 YUCAIPA BLVD, YUCAIPA, CA 92399
(909) 790-7900
Mailing address
33353 YUCAIPA BLVD, YUCAIPA, CA 92399-2018
(909) 790-7900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01078576A
IN
208000000X
Pediatrics Physician
C54711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730285123
CALIFORNIA CHILDREN'S SERVICES (CCS)
CA
01
—
1730285123
NPI
—
05
—
300002637
—
IN
Enumeration date
09/15/2006
Last updated
09/04/2018
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