Provider Demographics
NPI:1851834717
Name:PONS CRUZ, IRIS HEIDSHA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:HEIDSHA
Last Name:PONS CRUZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CALLE ANIBAL ST
Mailing Address - Street 2:CONDOMINIO TWIN TOWER APT 103
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-306-6573
Mailing Address - Fax:
Practice Address - Street 1:1349 CALLE SALUD SUITE 3
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-840-7747
Practice Address - Fax:787-840-7747
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist