Healthcare Provider Details

I. General information

NPI: 1689853947
Provider Name (Legal Business Name): CYRIAC K CHEMPLAVIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 S PECOS RD #11A
HENDERSON NV
89074-7158
US

IV. Provider business mailing address

8965 S PECOS RD STE 11A
HENDERSON NV
89074-7158
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-4094
  • Fax: 702-735-1994
Mailing address:
  • Phone: 702-735-4094
  • Fax: 702-735-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4180
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: