Provider Demographics
NPI:1700779618
Name:PONPA, ISAIAS
Entity type:Individual
Prefix:
First Name:ISAIAS
Middle Name:
Last Name:PONPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-2539
Mailing Address - Country:US
Mailing Address - Phone:331-205-0569
Mailing Address - Fax:
Practice Address - Street 1:420 PENNSYLVANIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4427
Practice Address - Country:US
Practice Address - Phone:630-474-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker