Provider Demographics
NPI:1851336085
Name:PONS DAMIANI, PABLO E (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:E
Last Name:PONS DAMIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O.BOX 538
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0538
Mailing Address - Country:US
Mailing Address - Phone:939-214-7032
Mailing Address - Fax:939-214-7032
Practice Address - Street 1:CARR. 116 KM. 0.5
Practice Address - Street 2:ALTOS PHARMAMAX
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:939-214-7032
Practice Address - Fax:939-214-7032
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073700208000000X
PR7509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4866345Medicaid