Provider Demographics
NPI:1558304436
Name:PONGOS, MARIA SOCORRO S (MD)
Entity Type:Individual
Prefix:
First Name:MARIA SOCORRO
Middle Name:S
Last Name:PONGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3177
Mailing Address - Country:US
Mailing Address - Phone:863-318-1111
Mailing Address - Fax:863-318-1102
Practice Address - Street 1:6270 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3177
Practice Address - Country:US
Practice Address - Phone:863-318-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3503308OtherAETNA
FL58040OtherBLUE CROSS
FL404404800OtherCIGNA
FLF9494584306OtherBEECHSTREET
FL58040OtherBLUE CROSS