Provider Demographics
NPI:1376972646
Name:PONTIS, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PONTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:PONTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 S MILLER ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5233
Mailing Address - Country:US
Mailing Address - Phone:805-925-9811
Mailing Address - Fax:
Practice Address - Street 1:201 S MILLER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5233
Practice Address - Country:US
Practice Address - Phone:805-925-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder