Provider Demographics
NPI:1225088537
Name:CLAVIJO, LEONARDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:C
Last Name:CLAVIJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:1941 JOHNSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:813-613-2634
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93873207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A938730197OtherCAL OPTIMA
CAGR0100430OtherGROUP MEDICAL
CAW18762OtherGROUP MEDICARE
CAP00400220OtherRAILROAD MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CAGR0100430OtherGROUP MEDICAL
CA1902846306OtherGROUP NPI
CAP00400220OtherRAILROAD MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CAGR0016910OtherGROUP MEDICAID PIN
CAW11675OtherGROUP MEDICARE PIN
CAWA93873AMedicare PIN
CAP00400220OtherRAILROAD MEDICARE