Provider Demographics
NPI:1164659033
Name:PONCE, SONIA GABRIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:GABRIELA
Last Name:PONCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 4TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:197-549-5006
Mailing Address - Fax:
Practice Address - Street 1:340 FOURTH AVE STE 11
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-754-9500
Practice Address - Fax:619-489-6177
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA145008207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist