Provider Demographics
NPI:1891577110
Name:PONCE, ANDREA PAOLA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:PAOLA
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 1:839 CALLE ANASCO APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2452
Mailing Address - Country:US
Mailing Address - Phone:787-246-9255
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL OFFICES PARK IV 997 SAN ROBERTO STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-246-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program