Provider Demographics
NPI:1548573793
Name:MONTECLARO, CLARENCE CANLAPAN (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:CANLAPAN
Last Name:MONTECLARO
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2604
Mailing Address - Country:US
Mailing Address - Phone:310-404-2040
Mailing Address - Fax:
Practice Address - Street 1:1325 BROAD AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2604
Practice Address - Country:US
Practice Address - Phone:310-404-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine