Provider Demographics
NPI:1881300978
Name:CARIAS-BONILLA, LESLEY J
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:J
Last Name:CARIAS-BONILLA
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 1:7630 RIVA RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1607
Mailing Address - Country:US
Mailing Address - Phone:775-997-5831
Mailing Address - Fax:
Practice Address - Street 1:7630 RIVA RIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1607
Practice Address - Country:US
Practice Address - Phone:775-997-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician