Provider Demographics
NPI:1821387879
Name:QUEROL, CLIFFORD ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ALEXANDER
Last Name:QUEROL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLIFFORD
Other - Middle Name:ALEXANDER
Other - Last Name:GIMENEZ-QUEROL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21263 ERWIN ST
Mailing Address - Street 2:PSYCHIATRY DEPARTMENT
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:818-592-3195
Mailing Address - Fax:212-420-4332
Practice Address - Street 1:21263 ERWIN ST
Practice Address - Street 2:PSYCHIATRY DEPARTMENT
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:818-592-3195
Practice Address - Fax:212-420-4332
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4434052084P0800X
NY2886292084P0800X
CAA1317442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry