Active NPI
Michael Ponco Fontelera
- Durable Medical Equipment & Medical Supplies
- Livermore, CA
National Provider Identifier
1164436382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 44039
- Practice address
- 4049 First St
Suite 134
Livermore, CA 94551-5379 - Phone
- (925) 249-1400
- Fax
- (925) 249-1414
- NPI assigned
- Jul 27, 2006
- Last updated
- May 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 44039 | CA | Primary |
Addresses
Primary practice location
4049 First St
Suite 134
Livermore, CA 94551-5379
Mailing address
PO Box 2111
Livermore, CA 94551-2111
Phone (925) 249-1400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44039 | CA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1164436382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2111",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945512111",
"telephone_number": "925-249-1400",
"fax_number": "925-249-1414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4049 FIRST ST",
"address_2": "SUITE 134",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945515379",
"telephone_number": "925-249-1400",
"fax_number": "925-249-1414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTELERA",
"first_name": "MICHAEL",
"middle_name": "PONCO",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "44039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.