Provider Demographics
NPI:1447451695
Name:PONS, JOSE I (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:I
Last Name:PONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1659 CALLE MARQUESA
Mailing Address - Street 2:URB. VALLE REAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0503
Mailing Address - Country:US
Mailing Address - Phone:787-848-9324
Mailing Address - Fax:
Practice Address - Street 1:2225 PONCE BYP
Practice Address - Street 2:EDIF. PARRA, SUITE 304
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-848-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical