Organization
PONSOL FOUNTAINBLUE, LLC
Active
Other names
Ponsol Health
Organization subpart
No
Provider details
NPI number
Authorized official
PETER JOSEPH (PRESIDENT)
(786) 625-7100
Entity
Organization
Contact information
Practice address
2100 NW 107TH AVE STE 108, SWEETWATER, FL 33172-2506
(786) 625-7100
(786) 625-7111
Mailing address
7801 SW 125TH ST, PINECREST, FL 33156-6058
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/14/2022
Last updated
01/22/2026
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