Provider Demographics
NPI:1396947446
Name:PONCE, MONICA JOAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JOAN
Last Name:PONCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13254 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7916
Mailing Address - Country:US
Mailing Address - Phone:305-926-1845
Mailing Address - Fax:
Practice Address - Street 1:6280 SUNSET DR
Practice Address - Street 2:SUITE 502
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4827
Practice Address - Country:US
Practice Address - Phone:305-596-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant