Provider Demographics
NPI:1154492221
Name:PONS, MARIA DE LOS ANGELES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA DE LOS
Middle Name:ANGELES
Last Name:PONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 MEDICAL CENTER DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5539
Mailing Address - Country:US
Mailing Address - Phone:985-649-0076
Mailing Address - Fax:985-643-3099
Practice Address - Street 1:105 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 306
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5544
Practice Address - Country:US
Practice Address - Phone:985-643-3033
Practice Address - Fax:985-643-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.13867R2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124265Medicaid
LA1183296Medicaid
MS00124265Medicaid