Provider Demographics
NPI:1174685879
Name:PONCE SERVICES CORPORATION INC
Entity Type:Organization
Organization Name:PONCE SERVICES CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SABOGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-244-3967
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-244-3967
Mailing Address - Fax:
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 315
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-244-3967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC5507OtherAHCA CERTIFICATE OF EXEMP
FLHCC5507OtherAHCA CERTIFICATE OF EXEMP