MEDICARE: CLIVENSON DUBOIS

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1629885587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIVENSON DUBOIS

Provider Business Mailing Address
First Line	:	6067 BLUE STONE LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6067 BLUE STONE LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6720
Country	:	US
Telephone Number	:	321-265-4997
Fax Number	:

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

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/19/2024

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Directions to “ CLIVENSON DUBOIS ” Practice Location

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