Provider Demographics
NPI:1558166306
Name:COLLIER, CLIFTON
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:COLLIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29350 CORAL ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-3310
Mailing Address - Country:US
Mailing Address - Phone:847-691-9741
Mailing Address - Fax:
Practice Address - Street 1:29350 CORAL ISLAND CT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-3310
Practice Address - Country:US
Practice Address - Phone:847-691-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker