Healthcare Provider Details

I. General information

NPI: 1194521708
Provider Name (Legal Business Name): PAOLA NICOLE CLAVIJO COLON CRL, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/26/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. NO. 2 KM 8.2 BO. JUAN SANCHEZ
BAYAMON PR
00960-7087
US

IV. Provider business mailing address

A28 VILLAS DEL BOSQUE
CIDRA PR
00739-9202
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7575
  • Fax:
Mailing address:
  • Phone: 787-556-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number1806
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: