Provider Demographics
NPI:1669811840
Name:MILLER, CLEMENTE (LVN)
Entity type:Individual
Prefix:
First Name:CLEMENTE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 GLEESON CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1910
Mailing Address - Country:US
Mailing Address - Phone:661-384-1900
Mailing Address - Fax:
Practice Address - Street 1:718 WORKMAN STRRET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307
Practice Address - Country:US
Practice Address - Phone:661-335-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95418079163WP0808X
CA259037164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568219855OtherTELECARECORP