Healthcare Provider Details

I. General information

NPI: 1255625844
Provider Name (Legal Business Name): YULA PONTICAS, PH.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 KENILWORTH DR SUITE 210
TOWSON MD
21204-2101
US

IV. Provider business mailing address

1104 KENILWORTH DR SUITE 210
TOWSON MD
21204-2101
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-8824
  • Fax: 410-828-8823
Mailing address:
  • Phone: 410-828-8824
  • Fax: 410-828-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number02426
License Number StateMD

VIII. Authorized Official

Name: DR. YULA PONTICAS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 410-828-8824