Provider Demographics
NPI:1588083075
Name:CADANG, CLARISSE ELAINE (MD)
Entity type:Individual
Prefix:
First Name:CLARISSE
Middle Name:ELAINE
Last Name:CADANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 BUSINESS CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6888
Mailing Address - Country:US
Mailing Address - Phone:707-646-3500
Mailing Address - Fax:707-646-3501
Practice Address - Street 1:4520 BUSINESS CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-6888
Practice Address - Country:US
Practice Address - Phone:707-646-3500
Practice Address - Fax:707-646-3501
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0083367207R00000X
390200000X
CAA145810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program