Provider Demographics
NPI:1609027754
Name:CLOMERA, LEOVINO V JR (PA-C)
Entity Type:Individual
Prefix:
First Name:LEOVINO
Middle Name:V
Last Name:CLOMERA
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35574 DENVER CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8567
Mailing Address - Country:US
Mailing Address - Phone:951-599-4803
Mailing Address - Fax:
Practice Address - Street 1:1001 N STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1474
Practice Address - Country:US
Practice Address - Phone:951-652-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18575363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical