Healthcare Provider Details

I. General information

NPI: 1427051150
Provider Name (Legal Business Name): CLEMENTE PINEDA NUNAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2005
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10222 YALE AVE
WEEKI WACHEE FL
34613-8375
US

IV. Provider business mailing address

10222 YALE AVE
WEEKI WACHEE FL
34613-8375
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-9797
  • Fax: 352-597-5556
Mailing address:
  • Phone: 352-597-9797
  • Fax: 352-597-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME33352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: