MEDICARE: MR. AUBREY DEAN CLIFTON JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	B9628793	CA

General Provider Information

NPI Number	:	1174365175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUBREY DEAN CLIFTON JR.

Provider Business Mailing Address
First Line	:	5201 BANCROFT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-5305
Country	:	US
Telephone Number	:	240-550-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 BANCROFT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-5305
Country	:	US
Telephone Number	:	240-550-8050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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