Individual
CLIFTON A MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2750 E WASHINGTON BLVD, STE 330, PASADENA, CA 91107-1448
(626) 797-9883
(626) 797-9853
Mailing address
2750 E WASHINGTON BLVD, STE 330, PASADENA, CA 91107-1448
(626) 797-9883
(626) 797-9853
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G43796
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100002889
RAILROAD MEDICARE
CA
05
—
GR0029750
—
CA
Enumeration date
03/08/2007
Last updated
07/09/2007
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