Provider Demographics
NPI:1245331511
Name:CLEMENTE, JAVIER L (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:L
Last Name:CLEMENTE
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 1:18099 LORAIN AVE
Mailing Address - Street 2:STE 316
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111
Mailing Address - Country:US
Mailing Address - Phone:216-671-2322
Mailing Address - Fax:216-671-0140
Practice Address - Street 1:18099 LORAIN RD
Practice Address - Street 2:STE 316
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135
Practice Address - Country:US
Practice Address - Phone:216-671-2322
Practice Address - Fax:216-671-0140
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041323246ZN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12812OtherQUALCHOICE
OH0366223Medicaid
0560460014OtherBWC
000000130134OtherANTHEM
OH0366223Medicaid
C01524Medicare ID - Type Unspecified