Basic Information
| Provider Information | |||||||||
| NPI: | 1689647190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORDOVA | ||||||||
| FirstName: | SHEMROCK | ||||||||
| MiddleName: | OCTAVIO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W. CHARLESTON BLVD. STE. 508 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832688 | ||||||||
| FaxNumber: | 7026716595 | ||||||||
| Practice Location | |||||||||
| Address1: | 4760 BLUE DIAMOND RD. STE. 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832300 | ||||||||
| FaxNumber: | 7026781886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10709 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.