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NPI Code Detail

MEDICARE: ERIC NORBERT PONDROM

MEDICARE: ERIC NORBERT PONDROM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1447833793
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC NORBERT PONDROM
Provider Business Mailing Address
First Line : 2954 CHICAGO ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-6157
Country : US
Telephone Number : 858-568-8365
Fax Number :
Provider Business Practice Location Address
First Line : 5855 STREAMVIEW DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-3910
Country : US
Telephone Number : 619-287-5460
Fax Number : 619-287-5040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2021
Last Update Date : 05/14/2026

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Directions to “ ERIC NORBERT PONDROM ” Practice Location

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