Provider Demographics
NPI:1073988705
Name:PONTON, DAMARYS DIAZ
Entity Type:Individual
Prefix:
First Name:DAMARYS
Middle Name:DIAZ
Last Name:PONTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 PASEO SAN PEDRITO
Mailing Address - Street 2:SECTOR EL LAUREL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-376-4346
Mailing Address - Fax:
Practice Address - Street 1:604 PASEO SAN PEDRITO
Practice Address - Street 2:EL LAUREL
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2414
Practice Address - Country:US
Practice Address - Phone:787-376-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical