Healthcare Provider Details

I. General information

NPI: 1851336085
Provider Name (Legal Business Name): PABLO E PONS DAMIANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 116 KM. 0.5 ALTOS PHARMAMAX
LAJAS PR
00667
US

IV. Provider business mailing address

P.O.BOX 538
LAJAS PR
00667-0538
US

V. Phone/Fax

Practice location:
  • Phone: 939-214-7032
  • Fax: 939-214-7032
Mailing address:
  • Phone: 939-214-7032
  • Fax: 939-214-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301073700
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7509
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: