Organization Name: | BOHEME, LLC |
NPI Number: | 1689057655 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TANYA PHARES (MEDICAL DIRECTOR) |
Mailing Address: | 1100 Caughlin Xing Reno |
State: | NV US |
Postal Code: | 895190613 |
Phone Number: | 7758001724 |
Fax Number: | 7758001725 |
NPI Enumeration Date: | 07/08/2015 |
NPI Last Update Date: | 07/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |