Provider Demographics
NPI:1548224595
Name:CLAVELL, YOLANDA C (MD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:C
Last Name:CLAVELL
Suffix:
Gender:F
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:PO BOX 7685
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7685
Mailing Address - Country:US
Mailing Address - Phone:787-842-8111
Mailing Address - Fax:787-842-8111
Practice Address - Street 1:SAINT LUKES MEMORIAL HOSPITAL AVE TITO CASTRO 917
Practice Address - Street 2:LOBBY C
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-6810
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:787-842-8111
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81522Medicare ID - Type Unspecified
PRG40675Medicare UPIN