Provider Demographics
NPI:1619257029
Name:VISONA-PONS, CARINA LAURA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:LAURA
Last Name:VISONA-PONS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:CARINA
Other - Middle Name:LAURA
Other - Last Name:VISONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:822 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3017
Mailing Address - Country:US
Mailing Address - Phone:626-357-8543
Mailing Address - Fax:
Practice Address - Street 1:822 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016
Practice Address - Country:US
Practice Address - Phone:626-357-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20541363L00000X, 363LF0000X, 363LP2300X
MI4704351430363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily