MEDICARE: IVAN LLOYD BOAYES LAROGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN67684	NV

General Provider Information

NPI Number	:	1093505711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN LLOYD BOAYES LAROGA

Provider Business Mailing Address
First Line	:	1560 DARK WOLF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4859
Country	:	US
Telephone Number	:	702-720-0020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 DARK WOLF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4859
Country	:	US
Telephone Number	:	702-720-0020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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