Basic Information
| Provider Information | |||||||||
| NPI: | 1780813865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONTI | ||||||||
| FirstName: | CARLO | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4823 NW 91ST WAY | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330671908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | 9548392569 | ||||||||
| Practice Location | |||||||||
| Address1: | 4823 NW 91ST WAY | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330671908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547029672 | ||||||||
| FaxNumber: | 9547029672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2009 | ||||||||
| LastUpdateDate: | 05/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 5101018432 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | OS12336 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | DO1641 | NV | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.