Provider Demographics
NPI:1093067217
Name:POND, BRIAN W (PPS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:POND
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MOTAR AVENUE
Mailing Address - Street 2:VISTA DEL MAR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034
Mailing Address - Country:US
Mailing Address - Phone:310-836-1223
Mailing Address - Fax:
Practice Address - Street 1:3200 MOTAR AVENUE
Practice Address - Street 2:VISTA DEL MAR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:310-836-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor