Healthcare Provider Details

I. General information

NPI: 1528748944
Provider Name (Legal Business Name): CLIFFORD RONALD LAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STOCKDALE HWY STE 200
BAKERSFIELD CA
93309-2664
US

IV. Provider business mailing address

2131 PARK WAY APT A
BAKERSFIELD CA
93304-1114
US

V. Phone/Fax

Practice location:
  • Phone: 661-473-1500
  • Fax:
Mailing address:
  • Phone: 760-793-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95339350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: