Provider Demographics
NPI:1881828101
Name:PONCE, SARAH ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:PONCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:34910 INTERSTATE 10 W 3
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9229
Mailing Address - Country:US
Mailing Address - Phone:801-852-9888
Mailing Address - Fax:801-934-2301
Practice Address - Street 1:8401 DATAPOINT DR
Practice Address - Street 2:STE 865
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5900
Practice Address - Country:US
Practice Address - Phone:210-293-6006
Practice Address - Fax:210-293-6006
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06147363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical