1245331511 NPI number — JAVIER L CLEMENTE MD

Table of content: JAVIER L CLEMENTE MD (NPI 1245331511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245331511 NPI number — JAVIER L CLEMENTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENTE
Provider First Name:
JAVIER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245331511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18099 LORAIN AVE
Provider Second Line Business Mailing Address:
STE 316
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-671-2322
Provider Business Mailing Address Fax Number:
216-671-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18099 LORAIN RD
Provider Second Line Business Practice Location Address:
STE 316
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-671-2322
Provider Business Practice Location Address Fax Number:
216-671-0140
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZN0300X , with the licence number:  35041323 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12812 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0366223 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0560460014 . This is a "BWC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000130134 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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