Provider Demographics
NPI:1184068843
Name:PONCE PAIN DOC., INC.
Entity type:Organization
Organization Name:PONCE PAIN DOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-709-0574
Mailing Address - Street 1:1255 PASEO LAS MONJITAS
Mailing Address - Street 2:SUITE159
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4220
Mailing Address - Country:US
Mailing Address - Phone:787-840-1818
Mailing Address - Fax:
Practice Address - Street 1:1255 PASEO LAS MONJITAS
Practice Address - Street 2:SUITE159
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4220
Practice Address - Country:US
Practice Address - Phone:787-840-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management