Provider Demographics
NPI:1689057655
Name:BOHEME, LLC
Entity Type:Organization
Organization Name:BOHEME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-800-1724
Mailing Address - Street 1:1100 CAUGHLIN XING
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0613
Mailing Address - Country:US
Mailing Address - Phone:775-800-1724
Mailing Address - Fax:775-800-1725
Practice Address - Street 1:1100 CAUGHLIN XING
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0613
Practice Address - Country:US
Practice Address - Phone:775-800-1724
Practice Address - Fax:775-800-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty