Provider Demographics
NPI:1215768072
Name:EVA FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:EVA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVORGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-623-0220
Mailing Address - Street 1:3468 E SAHARA AVE STE 160A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-4827
Mailing Address - Country:US
Mailing Address - Phone:702-623-0220
Mailing Address - Fax:
Practice Address - Street 1:3468 E SAHARA AVE STE 160A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4827
Practice Address - Country:US
Practice Address - Phone:702-623-0220
Practice Address - Fax:702-213-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center