Provider Demographics
NPI:1508633058
Name:BANUCHI PONCE, PAOLO RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:RENE
Last Name:BANUCHI PONCE
Suffix:
Gender:M
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:HOSPITAL DE LA CONCEPCION
Mailing Address - Street 2:PR-2 KM 173,
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-533-7634
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DE LA CONCEPCION
Practice Address - Street 2:PR-2 KM 173,
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-533-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine