Provider Demographics
NPI:1689693962
Name:PADRON-SPENCE, CLARA (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:PADRON-SPENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:
Other - Last Name:PADRON-SPENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1503 N IMPERIAL AVE
Mailing Address - Street 2:204
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6301
Mailing Address - Country:US
Mailing Address - Phone:760-339-2802
Mailing Address - Fax:760-339-2829
Practice Address - Street 1:1503 N IMPERIAL AVE
Practice Address - Street 2:204
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6301
Practice Address - Country:US
Practice Address - Phone:760-339-2802
Practice Address - Fax:760-339-2829
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70432Medicare UPIN