Provider Demographics
NPI:1346500782
Name:PONCE DE LEON, MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:PONCE DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SW 27TH AVE STE 706
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2968
Mailing Address - Country:US
Mailing Address - Phone:786-305-4502
Mailing Address - Fax:305-603-7069
Practice Address - Street 1:330 SW 27TH AVE STE 706
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2968
Practice Address - Country:US
Practice Address - Phone:786-305-4502
Practice Address - Fax:305-603-7069
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044658207R00000X
FLME122121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine