Provider Demographics
NPI:1407253297
Name:CLIFTON, CORY M (IDC)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:M
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44 MENUSA DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7871
Mailing Address - Country:US
Mailing Address - Phone:910-546-1095
Mailing Address - Fax:
Practice Address - Street 1:BOX 7888260
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8260
Practice Address - Country:US
Practice Address - Phone:910-546-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14224091-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant