Provider Demographics
NPI:1487725552
Name:GIFFORD, PATRICIA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JANE
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22921 TRITON WAY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1236
Mailing Address - Country:US
Mailing Address - Phone:877-351-7710
Mailing Address - Fax:
Practice Address - Street 1:22921 TRITON WAY
Practice Address - Street 2:SUITE 125
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1236
Practice Address - Country:US
Practice Address - Phone:877-351-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35540207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91695Medicare UPIN