| Body Mind And Wellness Clinic Incorporated | |
|
2810 W Charleston Blvd Ste 57 Las Vegas NV 89102-1906 | |
| (702) 376-2485 | |
| Not Available |
| Full Name | Body Mind And Wellness Clinic Incorporated |
|---|---|
| Speciality | Family Medicine |
| Location | 2810 W Charleston Blvd Ste 57, Las Vegas, Nevada |
| Authorized Official Name and Position | Ivan Gil Llanes (OWNER AND DIRECTOR) |
| Authorized Official Contact | 7023762485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Body Mind And Wellness Clinic Incorporated 2810 W Charleston Blvd Ste 57 Las Vegas NV 89102-1906 Ph: () - | Body Mind And Wellness Clinic Incorporated 2810 W Charleston Blvd Ste 57 Las Vegas NV 89102-1906 Ph: (702) 376-2485 |
| NPI Number | 1730995929 |
|---|---|
| Provider Enumeration Date | 12/04/2024 |
| Last Update Date | 12/04/2024 |
| Certification Date | 12/04/2024 |
| Medicare PECOS PAC ID | 4082142336 |
|---|---|
| Medicare Enrollment ID | O20250114002281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730995929 | NPI | - | NPPES |
| Provider Name | Victor Knutzen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255679320 PECOS PAC ID: 7719117407 Enrollment ID: I20171130001620 |
| Provider Name | Junier Torres-quiala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427509850 PECOS PAC ID: 4981034493 Enrollment ID: I20200424001401 |
| Provider Name | Brandon Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033757711 PECOS PAC ID: 7810310687 Enrollment ID: I20200720001948 |
| Provider Name | Yalena Lezcano Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144845330 PECOS PAC ID: 4981055589 Enrollment ID: I20240108005947 |
| Provider Name | Amauri Santiago Rosales Ponce De Leon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205454295 PECOS PAC ID: 0749710259 Enrollment ID: I20250213002055 |
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