Provider Demographics
NPI:1104992635
Name:CLIFT, WARREN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:DAVID
Last Name:CLIFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3738
Mailing Address - Country:US
Mailing Address - Phone:209-466-3552
Mailing Address - Fax:
Practice Address - Street 1:2815 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3738
Practice Address - Country:US
Practice Address - Phone:209-466-3551
Practice Address - Fax:209-465-7437
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G164300Medicaid
CAA39797Medicare UPIN
00G164300Medicare PIN