Provider Demographics
NPI:1356763163
Name:RONDON CLAVO, CARLOS MAURICIO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MAURICIO
Last Name:RONDON CLAVO
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 1:1161 YORK AVE
Mailing Address - Street 2:APARTMENT 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7940
Mailing Address - Country:US
Mailing Address - Phone:917-226-9252
Mailing Address - Fax:
Practice Address - Street 1:1161 YORK AVE
Practice Address - Street 2:APARTMENT 7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7940
Practice Address - Country:US
Practice Address - Phone:917-226-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant