Provider Demographics
NPI:1902418965
Name:KLARISANA PHYSICIAN SERVICES PLLC
Entity Type:Organization
Organization Name:KLARISANA PHYSICIAN SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
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:844-455-2747
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 1:9195 GRANT ST STE 130
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4348
Practice Address - Country:US
Practice Address - Phone:844-455-2747
Practice Address - Fax:888-504-2390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLARISANA PHYSICIAN SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain