Provider Demographics
NPI:1154524676
Name:DEVARIE, CLEMENTINA JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLEMENTINA
Middle Name:
Last Name:DEVARIE
Suffix:JR
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CALLE TERESA JORNET
Mailing Address - Street 2:TROPICAL COURTS APT. #1704
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7591
Mailing Address - Country:US
Mailing Address - Phone:787-761-9954
Mailing Address - Fax:
Practice Address - Street 1:COMPLEJO CORRECIONAL DE BAYAMON
Practice Address - Street 2:AVE. CENTRAL JUANITA FINAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00955
Practice Address - Country:US
Practice Address - Phone:787-717-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9597208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice