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General NPI Number Information
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NPI Number | 1902059652
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Entity Type | Individual
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Provider Name | MIRELA PONDUCHI MD
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Gender | Female
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 2000 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85015-2443
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Country | US
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Telephone | 602-249-0212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 843763
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City | DALLAS
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State | TX
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Zip | 75284-3763
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Country | US
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Telephone | 469-505-1666
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Fax | 469-436-3937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036122646
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036.122646
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125-052075
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 42568
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License Number State | AZ
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