Healthcare Provider Details

I. General information

NPI: 1699201764
Provider Name (Legal Business Name): SARAH ANNE PONTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST UCSF BENIOFF CHILDREN'S HOSPITAL OAKLAND
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

1411 EAST 31ST STREET K6 PEDIATRICS
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA157261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: