Organization
BODY MIND AND WELLNESS CLINIC INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN GIL LLANES (OWNER AND DIRECTOR)
(702) 376-2485
Entity
Organization
Contact information
Practice address
2810 W CHARLESTON BLVD STE 57, LAS VEGAS, NV 89102-1906
(702) 376-2485
Mailing address
2810 W CHARLESTON BLVD STE 57, LAS VEGAS, NV 89102-1906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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