MEDICARE: LUIS DIEGO CLARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	C460524630310	FL
2	3747P1801X	Personal Care Attendant
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1386417376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS DIEGO CLARE

Provider Business Mailing Address
First Line	:	1836 BORDEAUX DR
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-2852
Country	:	US
Telephone Number	:	513-224-7305
Fax Number	:

Provider Business Practice Location Address
First Line	:	4139 DAYTON XENIA RD
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-1948
Country	:	US
Telephone Number	:	937-620-7219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	11/01/2023

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Directions to “ LUIS DIEGO CLARE ” Practice Location

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