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General NPI Number Information
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NPI Number | 1396116612
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Entity Type | Individual
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Provider Name | BERNARD ANTHONY CHAVIES M.S.,LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 4505 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89154-9900
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Country | US
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Telephone | 702-895-3380
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Fax | 702-895-4474
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Provider Business Mailing Address
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Address Line | 4505 S. MARYLAND PARKWAY BOX 450007
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City | LAS VEGAS
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State | NV
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Zip | 89154-0007
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Country | US
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Telephone | 702-895-3380
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Fax | 702-895-4474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0506006
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License Number State | NV
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