Provider Demographics
NPI:1710172648
Name:PONCE, FRANCES CATHERINE VICENCIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCES CATHERINE
Middle Name:VICENCIO
Last Name:PONCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FRANCES
Other - Middle Name:
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1993 ERRECART BLVD
Mailing Address - Street 2:GOLDEN HEALTH FAMILY MEDICAL CLINIC
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8334
Mailing Address - Country:US
Mailing Address - Phone:775-753-1049
Mailing Address - Fax:
Practice Address - Street 1:1993 ERRECART BLVD
Practice Address - Street 2:GOLDEN HEALTH FAMILY MEDICAL CLINIC
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8334
Practice Address - Country:US
Practice Address - Phone:775-753-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710172648Medicaid
NVBD724ZMedicare UPIN