Healthcare Provider Details

I. General information

NPI: 1053757609
Provider Name (Legal Business Name): PONTINE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12935 ALCOSTA BLVD UNIT 2037
SAN RAMON CA
94583-6098
US

IV. Provider business mailing address

12935 ALCOSTA BLVD UNIT 2037
SAN RAMON CA
94583-6098
US

V. Phone/Fax

Practice location:
  • Phone: 510-225-9090
  • Fax:
Mailing address:
  • Phone: 510-225-9090
  • Fax: 510-544-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA116785
License Number StateCA

VIII. Authorized Official

Name: DR. YUSUF HAROON AHMAD
Title or Position: PRESIDENT
Credential: MD
Phone: 510-225-9090