Provider Demographics
NPI:1962263855
Name:PONDUS MEDICAL CA, PC
Entity type:Organization
Organization Name:PONDUS MEDICAL CA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EZEQUIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:035-588-6673
Mailing Address - Street 1:15811 COLLINS AVE APT 1405
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4174
Mailing Address - Country:US
Mailing Address - Phone:305-588-6673
Mailing Address - Fax:
Practice Address - Street 1:330 N BRAND BLVD STE 700
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2336
Practice Address - Country:US
Practice Address - Phone:305-588-6673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty