Provider Demographics
NPI:1013384866
Name:KLARISANA PHYSICIAN SERVICES PLLC
Entity Type:Organization
Organization Name:KLARISANA PHYSICIAN SERVICES PLLC
Other - Org Name:KLARISANA PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-945-6054
Mailing Address - Street 1:8600 WURZBACH RD STE 1110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4334
Mailing Address - Country:US
Mailing Address - Phone:210-556-1430
Mailing Address - Fax:
Practice Address - Street 1:8600 WURZBACH RD STE 1110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-556-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty