Provider Demographics
NPI:1861436909
Name:PONTRELLI, GARY NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:NICHOLAS
Last Name:PONTRELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:365 ARTEMESIA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2238
Mailing Address - Country:US
Mailing Address - Phone:805-658-0225
Mailing Address - Fax:805-644-4583
Practice Address - Street 1:2065 SPERRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7451
Practice Address - Country:US
Practice Address - Phone:805-658-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45965207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology