Provider Demographics
NPI:1679076467
Name:BOLONG-PLEASANT, SIONISHA L
Entity Type:Individual
Prefix:
First Name:SIONISHA
Middle Name:L
Last Name:BOLONG-PLEASANT
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 1:6459 GOLDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1303
Mailing Address - Country:US
Mailing Address - Phone:702-816-3983
Mailing Address - Fax:
Practice Address - Street 1:7390 W SAHARA AVE STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2764
Practice Address - Country:US
Practice Address - Phone:702-816-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health