Healthcare Provider Details

I. General information

NPI: 1235526534
Provider Name (Legal Business Name): BONNIE KATHERINE BUCKLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 S RAINBOW BLVD STE 10
LAS VEGAS NV
89118-2503
US

IV. Provider business mailing address

6070 S RAINBOW BLVD STE 10
LAS VEGAS NV
89118-2503
US

V. Phone/Fax

Practice location:
  • Phone: 702-420-7222
  • Fax:
Mailing address:
  • Phone: 702-420-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101261849
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28263
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: