Individual
MARIO NATALE PONTICELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-3505
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-3505
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
950-25
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43244600
—
WI
01
—
P00695367
RAIL ROAD MEDICARE
WI
Enumeration date
05/03/2008
Last updated
01/05/2024
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