Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MD.13867R | LA |
NPI | 1154492221 |
---|---|
Provider Name | Dr. Maria De Los Angeles Pons |
First Address | Slidell, LA 70461-5539 |
Second Address | Slidell, LA 70461-5544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00124265 | (05) | MS |
1183296 | (05) | LA |
F03299 | (02) | LA |