Provider Demographics
NPI:1083847727
Name:ROMULO CLAVELO M D P A
Entity Type:Organization
Organization Name:ROMULO CLAVELO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMULO
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAVELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-543-5581
Mailing Address - Street 1:PO BOX 402054
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-0054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78 SW 13TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2479
Practice Address - Country:US
Practice Address - Phone:305-631-0470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90231208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266250700Medicaid
FL266250700Medicaid