MEDICARE: PATRICIA CLAVIJO

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952705345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CLAVIJO

Provider Business Mailing Address
First Line	:	13748 DORNOCH DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8816
Country	:	US
Telephone Number	:	321-279-4765
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N GOLDENROD RD
Second Line	:	SUITE 2
City	:	ORLANDO
State	:	FL
Zip	:	32807-8308
Country	:	US
Telephone Number	:	321-279-2174
Fax Number	:

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

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	08/31/2015

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Directions to “ PATRICIA CLAVIJO ” Practice Location

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