| David C Bonovich Md | |
|
20103 Lake Chabot Rd Castro Valley CA 94546-5305 | |
| (503) 579-5000 | |
| (503) 579-5001 |
| Full Name | David C Bonovich Md |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 20103 Lake Chabot Rd, Castro Valley, California |
| Authorized Official Name and Position | Leane Wadsworth (OFFICE MANAGER) |
| Authorized Official Contact | 5035795000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David C Bonovich Md 14780 Sw Osprey Dr Ste 325 Beaverton OR 97007-8069 Ph: (503) 579-5000 | David C Bonovich Md 20103 Lake Chabot Rd Castro Valley CA 94546-5305 Ph: (503) 579-5000 |
| NPI Number | 1508374489 |
|---|---|
| Provider Enumeration Date | 01/13/2018 |
| Last Update Date | 10/08/2018 |
| Medicare PECOS PAC ID | 3678822798 |
|---|---|
| Medicare Enrollment ID | O20180823001186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508374489 | NPI | - | NPPES |
| 7587738 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084V0102X | Psychiatry & Neurology - Vascular Neurology | G71726 (California) | Primary |
| Provider Name | David C Bonovich |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1518078443 PECOS PAC ID: 5698731396 Enrollment ID: I20041204000096 |
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