Provider Demographics
NPI:1336189315
Name:PONCE, GLORIA I (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:I
Last Name:PONCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CALLE AMOR
Mailing Address - Street 2:URB PARAISO DE MAYAQUEZ
Mailing Address - City:MAYAQUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-833-0685
Mailing Address - Fax:
Practice Address - Street 1:351 AVE. HOSTOS EDIF. MEDICAL EMPORIUM
Practice Address - Street 2:SUITE 412
Practice Address - City:MAYAQUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine