Provider Demographics
NPI:1477249118
Name:RADCLIFFE, STACY ANTONET (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANTONET
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44489 TOWN CENTER WAY # 1022
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2723
Mailing Address - Country:US
Mailing Address - Phone:760-501-1890
Mailing Address - Fax:
Practice Address - Street 1:73373 COUNTRY CLUB DR APT 2410
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-8648
Practice Address - Country:US
Practice Address - Phone:760-501-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT02015403246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy