MEDICARE: DR. YOLANDA C CLAVELL MD

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	174400000X	Specialist	9224	PR

General Provider Information

NPI Number	:	1548224595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOLANDA C CLAVELL MD

Provider Business Mailing Address
First Line	:	PO BOX 7685
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-7685
Country	:	US
Telephone Number	:	787-842-8111
Fax Number	:	787-842-8111

Provider Business Practice Location Address
First Line	:	SAINT LUKES MEMORIAL HOSPITAL AVE TITO CASTRO 917
Second Line	:	LOBBY C
City	:	PONCE
State	:	PR
Zip	:	00733-6810
Country	:	US
Telephone Number	:	787-844-2080
Fax Number	:	787-842-8111

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	12/02/2008

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