Provider Demographics
NPI:1932104262
Name:CLIFT, KATHY A (PA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:CLIFT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 NATIVIDAD RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3101
Mailing Address - Country:US
Mailing Address - Phone:831-757-8081
Mailing Address - Fax:831-757-0625
Practice Address - Street 1:1328 NATIVIDAD RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3101
Practice Address - Country:US
Practice Address - Phone:831-757-8081
Practice Address - Fax:831-757-0625
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ84660ZMedicare UPIN
CAP46884Medicare UPIN