| Name | KEVIN TEMPLAR, MD |
|---|---|
| Address | 5590 SAN FLORENTINE AVENUE |
| City | LAS VEGAS |
| State | NV |
| Zip | 89141 |
| Mailing Address | PO BOX 230610 |
| Mailing Address 2 | PO BOX 230610 |
| Mailing City | LAS VEGAS |
| Mailing State | NV |
| Mailing Zip | 891230011 |
| Agent Type | Noncommercial Registered Agent |
| Company | SHIVA MEDSPAS, LLC |
|---|---|
| Entity Number | LLC21222-2004 |
| NV Business ID | NV20041214590 |
| Company | SHIVAI INC |
|---|---|
| Entity Number | E0697462005-4 |
| NV Business ID | NV20051069500 |