DR. CLAYTON GARY JOHNSEN (NPI# 1003141318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003141318 |
| Entity Type | Individual |
| Full Name | DR. CLAYTON GARY JOHNSEN |
| Credential | D.P.M. |
| Practice Address |
1762 N Waterman Ave San Bernardino CA 92404-5130 |
| Practice Telephone | 9098863668 |
| Practice Fax Number | 9098865542 |
| Mailing Telephone | 9098863668 |
| Mailing Fax Number | 9098865542 |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2016-05-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | E4834 | CA | Podiatric Medicine & Surgery Service Providers |
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
PO60139080 | WA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE PTAN | CB220721 | 01 |
| Street Address |
1762 N WATERMAN AVE |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92404-5130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538188099 | Richard D. Garcia | Dentist | 1762 N Waterman Ave, San Bernardino, CA 92404-5130 | 2006-07-18 |
| 1285080978 | Pacific Coast Podiatry PC | Preferred Provider Organization | 1762 N Waterman Ave, San Bernardino, CA 92404-5130 | 2016-05-11 |
| 1972883536 | Moellmer, Inc. | Podiatrist | 1762 N Waterman Ave, San Bernardino, CA 92404-5130 | 2011-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740849363 | Danniella Alexandra Murillo | Physician Assistant | 2101 North Waterman Ave, San Bernardino, CA 92404 | 2019-06-07 |
| 1902377484 | Shauntel Renee Nelson | Student in an Organized Health Care Education/Training Program | 1481 N. Windsor Dr., San Bernardino, CA 92404 | 2018-12-10 |
| 1487123584 | Garrett M Grigg | Licensed Psychiatric Technician | 1481 N Windsor Dr, San Bernardino, CA 92404 | 2018-11-19 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1043703564 | Samantha Makpaiboonvatana | Optometrist | 1909 N Waterman Ave Ste 3, San Bernardino, CA 92404 | 2018-06-09 |
| 1861981623 | Christopher Windham | Behavior Technician | 2460 Fremontia Dr, San Bernardino, CA 92404 | 2018-05-08 |
| 1891145041 | Cynthia Lusy Gastelum | Marriage & Family Therapist | 1885 E Lynwood Dr Rm Se3, San Bernardino, CA 92404 | 2016-06-20 |
| 1336598259 | Foundation Enterprises LLC | Non-emergency Medical Transport (VAN) | 1663 Date Pl., #30390, San Bernardino, CA 92404 | 2016-06-10 |
| 1881042877 | Helen Ann Thompson | Speech-Language Pathologist | 1311 E. State St., San Bernardo, CA 92404 | 2016-05-31 |
| 1366839938 | Lanecia Richardson | Counselor | 135 Paul Drive, San Rafeal, CA 92404 | 2015-04-22 |
| Find all providers in zip 92404 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154352037 | San Bernardino Foot Clinic, Inc. | Podiatrist | 2095 N Waterman Ave, San Bernardino, CA 92404-4834 | 2006-07-06 |
| 1972883536 | Moellmer, Inc. | Podiatrist | 1762 N Waterman Ave, San Bernardino, CA 92404-5130 | 2011-08-26 |
| 1780694356 | Sang Dae Lee | Podiatrist | 2095 N Waterman Ave, San Bernardino, CA 92404-4834 | 2006-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114528726 | Millennium Foot and Ankle Institute PC | Podiatrist | 26235 Ravenhill Rd, Santa Clarita, CA 91387-4046 | 2020-11-02 |
| 1861008054 | Ronald J Belczyk, Dpm Inc. | Podiatrist | 5471 La Palma Ave Ste 106, La Palma, CA 90623-1792 | 2020-09-22 |
| 1174139356 | Ronald J Belczyk, Dpm Inc. | Podiatrist | 4911 Van Nuys Blvd Ste 100, Sherman Oaks, CA 91403-1746 | 2020-09-22 |
| 1093327231 | Upperline Healthcare California PC | Podiatrist | 2131 San Joaquin Hills Rd, Newport Beach, CA 92660-6507 | 2020-08-19 |
| 1841815545 | Kenny Au Quach | Podiatrist | 17100 Euclid St # 4004, Fountain Valley, CA 92708-4004 | 2020-06-09 |
| 1417579129 | Central California Leg, Foot, and Ankle Center, Inc. | Podiatrist | 11325 Park Square Dr Apt D204, Bakersfield, CA 93311-8854 | 2020-05-15 |
| 1487282109 | Laura Y Lee, Dpm Inc | Podiatrist | 5525 Forestwood Dr, Sacramento, CA 95842-2128 | 2020-03-29 |
| 1780211458 | Dupontdpm Inc. | Podiatrist | 651 1st St W Ste C, Sonoma, CA 95476-7046 | 2020-03-24 |
| 1659903722 | Bay Area Foot Care, Inc | Podiatrist | 5924 Stoneridge Dr Ste 102, Pleasanton, CA 94588-2750 | 2020-02-06 |
| 1780215210 | Albert Elhiani Dpm Inc | Podiatrist | 9340 W Pico Blvd Ste 2, Los Angeles, CA 90035-1255 | 2020-02-03 |
| Find all providers with the same taxonomy | ||||
| City | SAN BERNARDINO |
| Zip Code | 92404 |
Please comment or provide details below to improve the information on DR. CLAYTON GARY JOHNSEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.