Provider Demographics
NPI:1619385739
Name:PONTECORVO, ROBERT RONNIE JR (ACUPUNCTURE)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RONNIE
Last Name:PONTECORVO
Suffix:JR
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5222 BALBOA AVE STE 43
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6956
Mailing Address - Country:US
Mailing Address - Phone:877-909-0508
Mailing Address - Fax:858-225-1367
Practice Address - Street 1:5222 BALBOA AVE STE 43
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6956
Practice Address - Country:US
Practice Address - Phone:877-909-0508
Practice Address - Fax:858-225-1367
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15877171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist