Provider Demographics
NPI:1013202241
Name:RESTER, CLIFTON ROBERT (LVN)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:ROBERT
Last Name:RESTER
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 W PENNSYLVANIA AVE
Mailing Address - Street 2:#105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3849
Mailing Address - Country:US
Mailing Address - Phone:619-507-6127
Mailing Address - Fax:
Practice Address - Street 1:836 W PENNSYLVANIA AVE
Practice Address - Street 2:#105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3849
Practice Address - Country:US
Practice Address - Phone:619-507-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245546164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse