Provider Demographics
NPI:1639724792
Name:BONSON, ELSABETH DAPHNE
Entity Type:Individual
Prefix:
First Name:ELSABETH
Middle Name:DAPHNE
Last Name:BONSON
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 1:13846 CRESTED RISE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1453
Mailing Address - Country:US
Mailing Address - Phone:814-574-4535
Mailing Address - Fax:
Practice Address - Street 1:13846 CRESTED RISE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1453
Practice Address - Country:US
Practice Address - Phone:814-574-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic