Provider Demographics
NPI:1154025351
Name:PONCE, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:PONCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5502
Mailing Address - Country:US
Mailing Address - Phone:786-592-1574
Mailing Address - Fax:305-489-5972
Practice Address - Street 1:18220 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5502
Practice Address - Country:US
Practice Address - Phone:786-592-1574
Practice Address - Fax:305-489-5972
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician