Provider Demographics
NPI:1780645333
Name:CLEMENTE P NUNAG MD PA
Entity type:Organization
Organization Name:CLEMENTE P NUNAG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:NUNAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-9797
Mailing Address - Street 1:10222 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-8375
Mailing Address - Country:US
Mailing Address - Phone:352-597-9797
Mailing Address - Fax:352-597-5556
Practice Address - Street 1:10222 YALE AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-8375
Practice Address - Country:US
Practice Address - Phone:352-597-9797
Practice Address - Fax:352-597-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89446207R00000X
FLME82024207Q00000X, 207R00000X
FLME33352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4459Medicare ID - Type UnspecifiedMEDICARE GROUP #