Provider Information for 1912670639
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AMY CLANCY WATSON-CLANCY
Sex: Female
NPI: 1912670639
Last Updated: 2022-12-02
Certification Date: 2022-12-02
Certification Date: 2022-12-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1912670639 | ||||||||
| Enumeration Date | 2021-07-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1427 HESKET WAY SACRAMENTO, CA 95825-5101 United States Phone: 916-207-4033 | Fax: | ||||||||
| Primary Practice Address | 77 CADILLAC DR SACRAMENTO, CA 95825-5453 United States Phone: 916-454-2345 | Fax:916-457-2667 | ||||||||
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