Provider Demographics
NPI:1114369261
Name:BOLDEN, SANDRA YVONNE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:YVONNE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7548 W SAHARA AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2778
Mailing Address - Country:US
Mailing Address - Phone:702-823-2313
Mailing Address - Fax:
Practice Address - Street 1:7548 W SAHARA AVE
Practice Address - Street 2:STE. 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2778
Practice Address - Country:US
Practice Address - Phone:702-823-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner