Basic Information
| Provider Information | |||||||||
| NPI: | 1508134008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAVIJO | ||||||||
| FirstName: | LILIANA | ||||||||
| MiddleName: | CRISTINA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 SW 1ST AVE | ||||||||
| Address2: | 1414 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331291179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058247541 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2121 PONCE DE LEON BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331345224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054474150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9106369 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.