Provider Demographics
NPI:1336321595
Name:POND, VIRGINIA KAE
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:KAE
Last Name:POND
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 1:4545 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1452
Mailing Address - Country:US
Mailing Address - Phone:916-736-0828
Mailing Address - Fax:916-736-0395
Practice Address - Street 1:4545 9TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1452
Practice Address - Country:US
Practice Address - Phone:916-736-0828
Practice Address - Fax:916-736-0395
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator