Provider Demographics
NPI:1245712314
Name:PONCE, TOMAS DE JESUS (BS, SLPA)
Entity type:Individual
Prefix:
First Name:TOMAS
Middle Name:DE JESUS
Last Name:PONCE
Suffix:
Gender:M
Credentials:BS, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 W GARRISON DR APT 4
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-0284
Mailing Address - Country:US
Mailing Address - Phone:956-453-3978
Mailing Address - Fax:
Practice Address - Street 1:1713 W GARRISON DR APT 4
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-0284
Practice Address - Country:US
Practice Address - Phone:956-453-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist