MEDICARE: MS. LESLIE TORIN BONETT SP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP4653	CA

General Provider Information

NPI Number	:	1467791467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE TORIN BONETT SP

Provider Business Mailing Address
First Line	:	2225 ROSEDALE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-4325
Country	:	US
Telephone Number	:	510-534-2750
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 ROSEDALE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-4325
Country	:	US
Telephone Number	:	510-534-2750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	02/11/2013

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