Healthcare Provider Details

I. General information

NPI: 1093505711
Provider Name (Legal Business Name): IVAN LLOYD BOAYES LAROGA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W LAKE MEAD PKWY
HENDERSON NV
89015-6954
US

IV. Provider business mailing address

129 W LAKE MEAD PKWY
HENDERSON NV
89015-6954
US

V. Phone/Fax

Practice location:
  • Phone: 702-285-8311
  • Fax:
Mailing address:
  • Phone: 702-285-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905096
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: