Individual
MR. MAURICIO EDGARDO PONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
835 3RD AVE STE A, CHULA VISTA, CA 91911-1352
(619) 425-7755
(619) 425-2138
Mailing address
835 3RD AVE STE A, CHULA VISTA, CA 91911-1352
(619) 425-7755
(619) 425-2138
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
A87650
CA
207W00000X
Ophthalmology Physician
M8258
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
A87650
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189743101
—
TX
05
—
189743102
—
TX
Enumeration date
11/14/2007
Last updated
04/05/2017
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