Active NPI
Clarence Sutton
- General Practice Physician
- N Hollywood, CA
National Provider Identifier
1174674774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- G74582
- Practice address
- 12805 Victory Blvd
N Hollywood, CA 91606-3012 - Phone
- (818) 506-5906
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | G74582 | CA | Primary |
Addresses
Primary practice location
12805 Victory Blvd
N Hollywood, CA 91606-3012
Mailing address
12805 Victory Blvd
N Hollywood, CA 91606-3012
Phone (818) 506-5906
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G74582 | Other | CA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G74582 | CA | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moussavi & Tovanyan Medical Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba SC Medical & Wellness
- Foot & Ankle Surgery Podiatrist
- N Hollywood, CA
- NPI 1912292947
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174674774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12805 VICTORY BLVD",
"city": "N HOLLYWOOD",
"state": "CA",
"postal_code": "916063012",
"telephone_number": "818-506-5906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12805 VICTORY BLVD",
"city": "N HOLLYWOOD",
"state": "CA",
"postal_code": "916063012",
"telephone_number": "818-506-5906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTTON",
"first_name": "CLARENCE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "G74582",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "G74582",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in N Hollywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.