Provider Demographics
NPI:1194949131
Name:LOVE YOUR BODY MEDICAL SPA
Entity type:Organization
Organization Name:LOVE YOUR BODY MEDICAL SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-649-5683
Mailing Address - Street 1:5693 S JONES BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1965
Mailing Address - Country:US
Mailing Address - Phone:702-649-5683
Mailing Address - Fax:702-222-3683
Practice Address - Street 1:5693 S JONES BLVD
Practice Address - Street 2:STE 108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1965
Practice Address - Country:US
Practice Address - Phone:702-649-5683
Practice Address - Fax:702-222-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7308174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty