Provider Demographics
NPI:1336569508
Name:BOLANOS, DENISE ELIZABETH (LMT)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ELIZABETH
Last Name:BOLANOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:E
Other - Last Name:WILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:6301 MOUNTAIN VISTA STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2366
Mailing Address - Country:US
Mailing Address - Phone:702-810-0082
Mailing Address - Fax:
Practice Address - Street 1:6301 MOUNTAIN VISTA STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2366
Practice Address - Country:US
Practice Address - Phone:702-810-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.6185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist