Provider Demographics
NPI:1154736684
Name:CLEMENT, CORY (DPM)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 N MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1328
Mailing Address - Country:US
Mailing Address - Phone:818-898-1388
Mailing Address - Fax:818-270-9590
Practice Address - Street 1:1600 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3115
Practice Address - Country:US
Practice Address - Phone:818-365-8086
Practice Address - Fax:818-365-6916
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2022-01-08
Deactivation Date:2018-06-04
Deactivation Code:
Reactivation Date:2018-06-20
Provider Licenses
StateLicense IDTaxonomies
CAE5365213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery