Provider Demographics
NPI:1871054791
Name:PONCE, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LOS AMIGOS
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-9024
Mailing Address - Country:US
Mailing Address - Phone:956-793-6709
Mailing Address - Fax:
Practice Address - Street 1:119 W VAN BUREN AVE STE 206
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6400
Practice Address - Country:US
Practice Address - Phone:956-793-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management