Provider Demographics
NPI:1912369927
Name:ALIFANO, JESSE ADAM (DO)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ADAM
Last Name:ALIFANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 N HALIFAX AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7276
Mailing Address - Country:US
Mailing Address - Phone:559-603-7415
Mailing Address - Fax:
Practice Address - Street 1:585 N HALIFAX AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7271
Practice Address - Country:US
Practice Address - Phone:559-603-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15964208000000X
CA15964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics