1538552559 NPI number — TERENCE MICHAEL CLIFTON

Table of content: TERENCE MICHAEL CLIFTON (NPI 1538552559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538552559 NPI number — TERENCE MICHAEL CLIFTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLIFTON
Provider First Name:
TERENCE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538552559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2555 HOMESTEAD RD APT 48
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95051-5346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-202-5075
Provider Business Mailing Address Fax Number:
408-202-5075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 THE ALAMEDA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-261-7777
Provider Business Practice Location Address Fax Number:
408-259-2273
Provider Enumeration Date:
03/16/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  VN 263311 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)