Organization
DAVID C BONOVICH MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANE WADSWORTH (OFFICE MANAGER)
(503) 579-5000
Entity
Organization
Contact information
Practice address
20103 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5305
(503) 579-5000
(503) 579-5001
Mailing address
14780 SW OSPREY DR STE 325, BEAVERTON, OR 97007-8069
(503) 579-5000
(503) 579-5001
Taxonomy
Speciality
Code
Description
License number
State
2084V0102X
Vascular Neurology Physician
Primary
G71726
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7587738
—
CA
Enumeration date
01/13/2018
Last updated
10/08/2018
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