MEDICARE: SANDRA YVONNE BOLDEN

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

General Provider Information

NPI Number	:	1114369261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA YVONNE BOLDEN

Provider Business Mailing Address
First Line	:	7548 W SAHARA AVE
Second Line	:	STE. 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2778
Country	:	US
Telephone Number	:	702-823-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	7548 W SAHARA AVE
Second Line	:	STE. 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2778
Country	:	US
Telephone Number	:	702-823-2313
Fax Number	:

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	02/16/2015

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Directions to “ SANDRA YVONNE BOLDEN ” Practice Location

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