=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649654245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONOVEX MEDICAL SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2015
-----------------------------------------------------
Last Update Date | 07/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19179 BLANCO RD SUITE 105 / UNIT 482
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-766-6839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19179 BLANCO RD SUITE 105 / UNIT 482
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-766-6839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CARL J BONNETT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 303-945-6054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------