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General NPI Number Information
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NPI Number | 1962263855
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Entity Type | Organization
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Legal Business Name | PONDUS MEDICAL CA, PC
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 330 N BRAND BLVD STE 700
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City | GLENDALE
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State | CA
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Zip | 91203-2336
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Country | US
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Telephone | 305-588-6673
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Fax |
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Provider Business Mailing Address
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Address Line | 15811 COLLINS AVE APT 1405
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4174
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Country | US
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Telephone | 305-588-6673
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | EZEQUIEL HALAC
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Credential |
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Telephone | 35-588-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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