Provider Demographics
NPI:1639058811
Name:PONS, SAMANTHA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PONS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14975 AVENIDA ANITA
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6210
Mailing Address - Country:US
Mailing Address - Phone:626-378-1523
Mailing Address - Fax:
Practice Address - Street 1:99 N SAN ANTONIO AVE STE 335
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4575
Practice Address - Country:US
Practice Address - Phone:909-716-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner