Provider Demographics
NPI:1740549237
Name:PONCE, ALEJANDRA (DO)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 BOCA CHICA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2368
Mailing Address - Country:US
Mailing Address - Phone:956-350-2973
Mailing Address - Fax:
Practice Address - Street 1:2449 BOCA CHICA BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2368
Practice Address - Country:US
Practice Address - Phone:956-350-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX510443ZV36Medicare PIN