Provider Demographics
NPI:1699705806
Name:CLIFFORD, JENNY T (MD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:T
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1654 LA MANCHA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6727
Mailing Address - Country:US
Mailing Address - Phone:214-621-7813
Mailing Address - Fax:
Practice Address - Street 1:3500 FIFTH AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5020
Practice Address - Country:US
Practice Address - Phone:619-295-3911
Practice Address - Fax:619-295-4356
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9853208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119108203Medicaid
TXF59219Medicare UPIN
TX119108203Medicaid