Healthcare Provider Details

I. General information

NPI: 1467576736
Provider Name (Legal Business Name): OFELIA C CLAROS RN BSN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-4213
  • Fax: 619-280-3545
Mailing address:
  • Phone: 619-280-4213
  • Fax: 619-280-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN273342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: