Provider Demographics
NPI:1255755641
Name:CLEMENTE, MARGARITA ODALYZ
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:ODALYZ
Last Name:CLEMENTE
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 1:1991 W 16TH CT
Mailing Address - Street 2:APT C
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-5059
Mailing Address - Country:US
Mailing Address - Phone:561-248-4157
Mailing Address - Fax:
Practice Address - Street 1:1991 W 16TH CT
Practice Address - Street 2:APT C
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-5059
Practice Address - Country:US
Practice Address - Phone:561-248-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant