Provider Demographics
NPI:1467952424
Name:BONAFACIO, ELSIE G
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:G
Last Name:BONAFACIO
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 1:8363 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-0842
Mailing Address - Country:US
Mailing Address - Phone:702-541-2824
Mailing Address - Fax:
Practice Address - Street 1:8363 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-0842
Practice Address - Country:US
Practice Address - Phone:702-541-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider