Provider Demographics
NPI:1376383166
Name:PONDS, FERNANDO L
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:L
Last Name:PONDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MOSS SPRINGS RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5140
Mailing Address - Country:US
Mailing Address - Phone:704-400-6358
Mailing Address - Fax:
Practice Address - Street 1:107 MOSS SPRINGS RD STE B
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5140
Practice Address - Country:US
Practice Address - Phone:704-400-6358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment