Provider Demographics
NPI:1487639845
Name:CLAVELL, LUIS ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:CLAVELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:252 CALLE SAN JORGE STE 504
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3241
Mailing Address - Country:US
Mailing Address - Phone:787-728-1575
Mailing Address - Fax:787-726-0402
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:SUITE #504 SAN JORGE MEDICAL BUILDING
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3310
Practice Address - Country:US
Practice Address - Phone:787-728-1575
Practice Address - Fax:787-726-0402
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2024-08-07
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Provider Licenses
StateLicense IDTaxonomies
PR57622080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38112500Medicaid