Provider Demographics
NPI:1023021409
Name:RASQUINHA, CLEMENCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENCIA
Middle Name:
Last Name:RASQUINHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLEMENCIA
Other - Middle Name:
Other - Last Name:DUBLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1415 LILAC DR N STE 190
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4544
Mailing Address - Country:US
Mailing Address - Phone:763-267-8701
Mailing Address - Fax:763-231-9602
Practice Address - Street 1:1415 LILAC DR N STE 190
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4544
Practice Address - Country:US
Practice Address - Phone:763-267-8701
Practice Address - Fax:763-231-9602
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60102207RG0300X, 207QG0300X
CO40773207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56229216Medicaid
COCOA104688Medicare PIN
CO56229216Medicaid
CO477438Medicare PIN