Provider Demographics
NPI:1578596201
Name:TIPPS, ANN MARIE PONSFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE PONSFORD
Last Name:TIPPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:MARIE PONSFORD
Other - Last Name:LAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:800-926-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57463207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G574630Medicaid
CAWG57463GMedicare ID - Type Unspecified
CA00G574630Medicaid