Provider Demographics
NPI:1992450514
Name:CLERVEAU-GRANT, CHASE
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:CLERVEAU-GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4511
Mailing Address - Country:US
Mailing Address - Phone:954-536-3991
Mailing Address - Fax:
Practice Address - Street 1:1429 CAPISTRANO AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4511
Practice Address - Country:US
Practice Address - Phone:954-536-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program