Provider Demographics
NPI:1730600222
Name:BONSALL, CHRIS SR
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:BONSALL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 BANGOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3602
Mailing Address - Country:US
Mailing Address - Phone:408-218-5211
Mailing Address - Fax:650-938-4091
Practice Address - Street 1:1350 GRANT RD STE 14B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3248
Practice Address - Country:US
Practice Address - Phone:650-938-4091
Practice Address - Fax:650-938-4092
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist