Provider Demographics
NPI:1659568046
Name:STRUMILLO, CLEMENT J (DO)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:J
Last Name:STRUMILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5182
Mailing Address - Country:US
Mailing Address - Phone:702-315-4600
Mailing Address - Fax:702-315-4607
Practice Address - Street 1:2685 S RAINBOW BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5182
Practice Address - Country:US
Practice Address - Phone:702-315-4600
Practice Address - Fax:702-315-4607
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
V37852OtherMEDICARE INDIVDUAL #
NV2019399Medicaid
V37851OtherMEDICARE GROUP/ORGANIZATIONAL #
V37851OtherMEDICARE GROUP/ORGANIZATIONAL #