=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508765918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA PONDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2026
-----------------------------------------------------
Last Update Date | 11/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 ELIZABETH LAKE RD
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-335-8710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 KENSINGTON NORTH ST
-----------------------------------------------------
City | NEW HUDSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48165-9769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-945-1767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------