Provider Demographics
NPI:1881212967
Name:PONCE, JEYNA EBONY ESPIRITU
Entity Type:Individual
Prefix:
First Name:JEYNA EBONY
Middle Name:ESPIRITU
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 EMERALD STONE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-3032
Mailing Address - Country:US
Mailing Address - Phone:702-743-1358
Mailing Address - Fax:702-359-4623
Practice Address - Street 1:1127 EMERALD STONE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-3032
Practice Address - Country:US
Practice Address - Phone:702-743-1358
Practice Address - Fax:702-359-4623
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant