Provider Demographics
NPI:1265932743
Name:PONCE, LUIS (RN , MSN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:PONCE
Suffix:
Gender:M
Credentials:RN , MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 LOS RANCHITOS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6737
Mailing Address - Country:US
Mailing Address - Phone:210-268-2632
Mailing Address - Fax:
Practice Address - Street 1:4514 LOS RANCHITOS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6737
Practice Address - Country:US
Practice Address - Phone:210-268-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse