Provider Demographics
NPI:1053483610
Name:ROBERT K CLIFFORD JR,
Entity Type:Organization
Organization Name:ROBERT K CLIFFORD JR,
Other - Org Name:AMERICAN ORTHOPEDIC & SPORTS MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:760-602-4148
Mailing Address - Street 1:317 N EL CAMINO REAL STE 405
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2815
Mailing Address - Country:US
Mailing Address - Phone:760-942-0565
Mailing Address - Fax:
Practice Address - Street 1:317 N EL CAMINO REAL STE 405
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2815
Practice Address - Country:US
Practice Address - Phone:760-942-0565
Practice Address - Fax:760-942-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13045Medicare PIN
CA1237780001Medicare NSC