Provider Demographics
NPI:1831705128
Name:DEBAUGH, CLIFTON
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:DEBAUGH
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 1:1030 S HUTCHINS ST STE 4-193
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5251
Mailing Address - Country:US
Mailing Address - Phone:209-663-3678
Mailing Address - Fax:
Practice Address - Street 1:20 N SUTTER ST STE 200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2911
Practice Address - Country:US
Practice Address - Phone:209-663-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty