Provider Demographics
NPI:1932221561
Name:MORONO PONCE, IDAYLIS (PHYSICIAN/MD)
Entity Type:Individual
Prefix:DR
First Name:IDAYLIS
Middle Name:
Last Name:MORONO PONCE
Suffix:
Gender:F
Credentials:PHYSICIAN/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8352 SW 40 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3354
Mailing Address - Country:US
Mailing Address - Phone:305-225-0707
Mailing Address - Fax:888-208-1644
Practice Address - Street 1:8352 SW 40 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3354
Practice Address - Country:US
Practice Address - Phone:305-225-0707
Practice Address - Fax:888-208-1644
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine