Provider Demographics
NPI:1871542464
Name:PONCE, MARY ZOILA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ZOILA
Last Name:PONCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4538 CENTERVIEW STE 154
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1308
Mailing Address - Country:US
Mailing Address - Phone:210-233-1566
Mailing Address - Fax:210-451-5746
Practice Address - Street 1:4538 CENTERVIEW STE 154
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1308
Practice Address - Country:US
Practice Address - Phone:210-233-1566
Practice Address - Fax:210-451-7466
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX30933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151905006Medicaid