Autumn Patricia Clos, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01078576A Issued in IN

Practice address

33353 Yucaipa Blvd
Yucaipa, CA 92399

Phone

(909) 790-7900

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Valley Children's Specialty Medical Group, Inc.

  • Pediatrics Physician
  • Madera, CA
  • NPI 1013968296
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536019200000",
    "number": "1730285123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33353 YUCAIPA BLVD",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992018",
            "telephone_number": "909-790-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33353 YUCAIPA BLVD",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "92399",
            "telephone_number": "909-790-7900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1441 Constitution Blvd",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Salinas",
            "state": "CA",
            "postal_code": "939063100",
            "country_code": "US",
            "telephone_number": "831-755-4124",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8921 Southpointe Dr Ste A1",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462271085",
            "country_code": "US",
            "telephone_number": "317-884-7820",
            "fax_number": "317-888-8851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLOS",
        "first_name": "AUTUMN",
        "middle_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2018-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C54711",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01078576A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1730285123",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300002637",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA CHILDREN'S SERVICES (CCS)",
            "identifier": "1730285123",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sudhakar R Chokka, DDS
• Pei-Jen Chu, L.AC.
• Hannah Lee Chuapoco, M.S., LMFT
• Kevin Chung, DDS
• Grace Enu Clerk, NP
• Cocoon Postpartum Doula Services
• William Brent Coffman, DDS
• Passion Zoey Coleman
• Diana Lizbeth Colon
• Lola Marlena Combs, LCSW

• Pediatrics Physician in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.