Provider Demographics
NPI:1811402688
Name:PAFFORD, PHIL
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:PAFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 NEVADA HWY # 414
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-1825
Mailing Address - Country:US
Mailing Address - Phone:951-317-5571
Mailing Address - Fax:951-444-7818
Practice Address - Street 1:19905 BEDFORD CANYON RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4827
Practice Address - Country:US
Practice Address - Phone:951-496-4248
Practice Address - Fax:951-444-7818
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2017-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor