Provider Demographics
NPI:1063484913
Name:CLAVELO, ROMULO (MDPA)
Entity Type:Individual
Prefix:DR
First Name:ROMULO
Middle Name:
Last Name:CLAVELO
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560832
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-0832
Mailing Address - Country:US
Mailing Address - Phone:305-631-0470
Mailing Address - Fax:305-631-9962
Practice Address - Street 1:1325 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2301
Practice Address - Country:US
Practice Address - Phone:305-631-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-05
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90231208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266250700Medicaid
FLE8361Medicare ID - Type Unspecified
FL266250700Medicaid