Provider Demographics
NPI:1407559297
Name:MOGOLLON, CLARIMAR
Entity Type:Individual
Prefix:
First Name:CLARIMAR
Middle Name:
Last Name:MOGOLLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 PONDER ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7616
Mailing Address - Country:US
Mailing Address - Phone:786-757-6580
Mailing Address - Fax:
Practice Address - Street 1:387 NATHAN DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7483
Practice Address - Country:US
Practice Address - Phone:740-310-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant