Healthcare Provider Details

I. General information

NPI: 1013445675
Provider Name (Legal Business Name): CLIFTON JAMES MARSCHEL CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

IV. Provider business mailing address

27 VISTA ALEGRE CT
SACRAMENTO CA
95831-4645
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-5811
  • Fax:
Mailing address:
  • Phone: 916-718-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberD7018027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: