MEDICARE: DR. LUIS ANTONIO CLAVELL M.D.

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	2080P0207X	Pediatric Hematology & Oncology Physician	5762	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487639845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ANTONIO CLAVELL M.D.

Provider Business Mailing Address
First Line	:	252 CALLE SAN JORGE STE 504
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3241
Country	:	US
Telephone Number	:	787-728-1575
Fax Number	:	787-726-0402

Provider Business Practice Location Address
First Line	:	252 CALLE SAN JORGE
Second Line	:	SUITE #504 SAN JORGE MEDICAL BUILDING
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3310
Country	:	US
Telephone Number	:	787-728-1575
Fax Number	:	787-726-0402

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	08/07/2024

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