Provider Demographics
NPI:1780729624
Name:PONCE, ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:667 CAPE COD DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-4605
Mailing Address - Country:US
Mailing Address - Phone:510-351-5025
Mailing Address - Fax:
Practice Address - Street 1:2620 26TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1907
Practice Address - Country:US
Practice Address - Phone:510-437-2363
Practice Address - Fax:510-437-2366
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist