Healthcare Provider Details

I. General information

NPI: 1972502425
Provider Name (Legal Business Name): CLIFTON COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N EL CIELO RD SUITE 140-701
PALM SPRINGS CA
92262-6992
US

IV. Provider business mailing address

255 N EL CIELO RD SUITE 140-701
PALM SPRINGS CA
92262-6992
US

V. Phone/Fax

Practice location:
  • Phone: 760-320-6677
  • Fax: 760-969-7238
Mailing address:
  • Phone: 760-320-6677
  • Fax: 760-969-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG48556
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberG48556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: