Provider Demographics
NPI:1245406834
Name:POMA, ALBERT
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:POMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 E DESERT BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-5812
Mailing Address - Country:US
Mailing Address - Phone:480-650-6412
Mailing Address - Fax:
Practice Address - Street 1:1598 E DESERT BREEZE DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5812
Practice Address - Country:US
Practice Address - Phone:480-650-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ806015171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor