Body Mind and Wellness Clinic Incorporated

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BODY MIND AND WELLNESS CLINIC INCORPORATED

Practice address

2810 W Charleston Blvd Ste 57
Las Vegas, NV 89102-1906

Phone

(702) 376-2485

NPI assigned

Dec 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ivan Gil Llanes

Title

Owner and Director

Phone

(702) 376-2485

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1730995929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 W CHARLESTON BLVD STE 57",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 W CHARLESTON BLVD STE 57",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021906",
            "telephone_number": "702-376-2485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODY MIND AND WELLNESS CLINIC INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "LLANES",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "GIL",
        "authorized_official_title_or_position": "OWNER AND DIRECTOR",
        "authorized_official_telephone_number": "702-376-2485"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Stephen Bodnar, RPH
• Stephanie Bodon
• Body & Mind Uplifment LLC
• Body and Mind Behavioral Services LLC
• Body Grace Medical Nutrition Therapy (Body Grace MNT)
• Body Resonance Myofascial Wellness Center, LLC
• Body Therapies of Nevada LLC (Structura Body Therapies)
• Gaylynn Boe
• Leigh Richards Boeckle, PA-C
• Annmarie L Boeger

• Family Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.