Healthcare Provider Details

I. General information

NPI: 1275243727
Provider Name (Legal Business Name): BONSTAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

10908 ATWELL AVE
BOWIE MD
20720-3598
US

V. Phone/Fax

Practice location:
  • Phone: 240-705-2473
  • Fax:
Mailing address:
  • Phone: 240-705-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BONAVENTURE ASONGACHE
Title or Position: CEO
Credential: BA
Phone: 240-705-0592