Provider Demographics
NPI:1174030738
Name:MAFFI-BOSCO, CLINTON STEVEN
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:STEVEN
Last Name:MAFFI-BOSCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3707
Mailing Address - Country:US
Mailing Address - Phone:775-624-8200
Mailing Address - Fax:775-624-8222
Practice Address - Street 1:1530 E 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-3707
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:775-624-8222
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty