Provider Demographics
NPI:1770940348
Name:PONSFORD, ALLYSON (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:PONSFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7632 HERSCHEL AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4403
Mailing Address - Country:US
Mailing Address - Phone:858-459-7768
Mailing Address - Fax:
Practice Address - Street 1:7632 HERSCHEL AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4403
Practice Address - Country:US
Practice Address - Phone:858-459-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist