Healthcare Provider Details

I. General information

NPI: 1780645333
Provider Name (Legal Business Name): CLEMENTE P NUNAG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/19/2008
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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME89446
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME82024
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82024
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME33352
License Number StateFL

VIII. Authorized Official

Name: DR. JOEL MENDOZA NUNAG
Title or Position: PHYSICIAN
Credential: MD
Phone: 352-597-9797