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General NPI Number Information
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NPI Number | 1013384866
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Entity Type | Organization
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Legal Business Name | KLARISANA PHYSICIAN SERVICES PLLC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1240 S PARKER RD STE 100
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City | DENVER
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State | CO
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Zip | 80231-2177
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 8670 WOLFF CT # 270
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City | WESTMINSTER
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State | CO
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Zip | 80031-6956
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Country | US
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Telephone | 844-455-2747
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Fax | 800-247-9785
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CARL JOHN BONNETT
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Credential | M.D.
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Telephone | 303-945-6054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | P8449
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License Number State | TX
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