Provider Demographics
NPI:1659349140
Name:CLAVECILLA, PIO (MD)
Entity Type:Individual
Prefix:
First Name:PIO
Middle Name:
Last Name:CLAVECILLA
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:PO BOX 15645
Mailing Address - Street 2:4475 S EASTERN AVENUE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-737-1880
Mailing Address - Fax:702-650-2458
Practice Address - Street 1:4475 S EASTERN AVENUE
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4153
Practice Address - Country:US
Practice Address - Phone:702-737-1880
Practice Address - Fax:702-650-2458
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12081207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00901960OtherRAILROAD PTAN MEDICARE
NV100510968Medicaid
NV100510968Medicaid
NVP00901960OtherRAILROAD PTAN MEDICARE
H05829Medicare UPIN
NVFO428ZMedicare PIN
NV103199Medicare PIN