MEDICARE: MR. STEVEN BONN

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	225400000X	Rehabilitation Practitioner
2	106H00000X	Marriage & Family Therapist	01239	NV

General Provider Information

NPI Number	:	1598062556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN BONN

Provider Business Mailing Address
First Line	:	2340 PASEO DEL PRADO # B-111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-431-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 PASEO DEL PRADO # B-111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-431-3626
Fax Number	:

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

Provider Enumeration Date	:	02/26/2011
Last Update Date	:	08/29/2015

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Directions to “ MR. STEVEN BONN ” Practice Location

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