Provider Demographics
NPI:1700295094
Name:PONCE PFT AND MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:PONCE PFT AND MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:EFRAIN
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:786-236-8899
Mailing Address - Street 1:335 S BISCAYNE BLVD APT 2210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2331
Mailing Address - Country:US
Mailing Address - Phone:786-236-8899
Mailing Address - Fax:
Practice Address - Street 1:21110 BISCAYNE BLVD., SUITE 303
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:786-236-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT919227800000X
FLTN23815291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty