Provider Demographics
NPI:1750360350
Name:PONTIUS, STEVEN C (MD, FACC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:PONTIUS
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23388207UN0901X, 207RC0000X
CA31700218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060007756OtherRAILROAD MEDICARE
CA00G233880Medicaid
CAZZZ24859ZOtherBLUE SHIELD
CAA41933Medicare UPIN
CAWG23388DMedicare PIN
CAWG23388AMedicare PIN
CAWG23388KMedicare PIN
CAWG23388EMedicare PIN
CA00G233880Medicaid
CAWG23388IMedicare PIN
CAWG23388CMedicare PIN
CA060007756OtherRAILROAD MEDICARE
CAWG23388GMedicare PIN