Provider Demographics
NPI:1689647190
Name:CORDOVA, SHEMROCK OCTAVIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEMROCK
Middle Name:OCTAVIO
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:702-671-6595
Practice Address - Street 1:4760 BLUE DIAMOND RD. STE. 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89137
Practice Address - Country:US
Practice Address - Phone:702-383-2300
Practice Address - Fax:702-678-1886
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV10709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine