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General NPI Number Information
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NPI Number | 1013627256
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Entity Type | Individual
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Provider Name | COLTON DALE CLIFTON
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Gender | Male
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2525 N CHESTER AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93308-1770
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Country | US
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Telephone | 661-304-3254
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 AUBURN ST APT 218
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City | BAKERSFIELD
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State | CA
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Zip | 93306-7201
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Country | US
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Telephone | 760-223-2285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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