Provider Demographics
NPI:1235674425
Name:BOBBY VAVLA, LLC
Entity type:Organization
Organization Name:BOBBY VAVLA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:VAVLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-461-2258
Mailing Address - Street 1:8987 W. FLAMINGO RD. #105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-0415
Mailing Address - Country:US
Mailing Address - Phone:702-461-2258
Mailing Address - Fax:702-952-0825
Practice Address - Street 1:8987 W FLAMINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0437
Practice Address - Country:US
Practice Address - Phone:702-461-2258
Practice Address - Fax:702-952-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty