Provider Demographics
NPI:1669146130
Name:PONCE, MARIA BENILDE
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:BENILDE
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77777 COUNTRY CLUB DR APT 274
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0465
Mailing Address - Country:US
Mailing Address - Phone:760-285-1478
Mailing Address - Fax:
Practice Address - Street 1:77777 COUNTRY CLUB DR APT 274
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0465
Practice Address - Country:US
Practice Address - Phone:760-285-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8842411172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver