Provider Demographics
NPI:1689853947
Name:CHEMPLAVIL, CYRIAC K (MD)
Entity Type:Individual
Prefix:
First Name:CYRIAC
Middle Name:K
Last Name:CHEMPLAVIL
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 1:8965 S PECOS RD
Mailing Address - Street 2:STE 11A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7158
Mailing Address - Country:US
Mailing Address - Phone:702-735-4094
Mailing Address - Fax:702-735-1994
Practice Address - Street 1:8965 S PECOS RD
Practice Address - Street 2:#11A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7158
Practice Address - Country:US
Practice Address - Phone:702-735-4094
Practice Address - Fax:702-735-1994
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002956Medicaid
C95877Medicare UPIN
NVVMD4180Medicare PIN