Provider Demographics
NPI:1013922400
Name:DUFFORD, DONALD B (PHD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:B
Last Name:DUFFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 STANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2768
Mailing Address - Country:US
Mailing Address - Phone:831-479-1960
Mailing Address - Fax:408-377-7833
Practice Address - Street 1:3880 S BASCOM AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2674
Practice Address - Country:US
Practice Address - Phone:408-559-9088
Practice Address - Fax:408-377-7833
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY134440Medicaid
CAPSY13444OtherCA STATE LICENSE
CAPSY134441Medicaid
CAPSY13444OtherCA STATE LICENSE
CAPSY134440Medicaid
CAPSY134441Medicaid