Provider Demographics
NPI:1225088537
Name:CLAVIJO, LEONARDO C (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:C
Last Name:CLAVIJO
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 1:6 WOODLAND RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9562
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:6 WOODLAND RD STE 304
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9562
Practice Address - Country:US
Practice Address - Phone:707-963-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93873207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18762OtherGROUP MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CAP00400220OtherRAILROAD MEDICARE
CA00A938730197OtherCAL OPTIMA
CAGR0100430OtherGROUP MEDICAL
CAGR0100430OtherGROUP MEDICAL
CA1902846306OtherGROUP NPI
CAP00400220OtherRAILROAD MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CAGR0016910OtherGROUP MEDICAID PIN
CAW11675OtherGROUP MEDICARE PIN
CAWA93873AMedicare PIN
CAP00400220OtherRAILROAD MEDICARE