Provider Demographics
NPI:1780806745
Name:EPSTEIN, CLARA RAQUEL (MD, FICS)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:RAQUEL
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:MD, FICS
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Mailing Address - Street 1:2121 CORRAL N
Mailing Address - Street 2:
Mailing Address - City:COTOPAXI
Mailing Address - State:CO
Mailing Address - Zip Code:81223-8898
Mailing Address - Country:US
Mailing Address - Phone:303-800-9129
Mailing Address - Fax:720-638-0497
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-9468
Practice Address - Country:US
Practice Address - Phone:303-800-9129
Practice Address - Fax:720-638-0497
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76471207T00000X
CO40083207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT061320120000590OtherMEDICARE, TRAILBLAZER HEALTH ENTERPRISES, LLC