Provider Demographics
NPI:1982843140
Name:PONTE, MAYA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:LOUISE
Last Name:PONTE
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:DEPARTMENT OF DERMATOLOGY UCSF
Mailing Address - Street 2:1701 DIVISADERO ST., THIRD FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-353-7800
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF DERMATOLOGY UCSF
Practice Address - Street 2:1701 DIVISADERO ST., THIRD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106431207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology