Provider Demographics
NPI:1528871027
Name:PONCE CASTILLO, JOSE RAMON
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:PONCE CASTILLO
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 1:1839 NW FLAGLER TER APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5434
Mailing Address - Country:US
Mailing Address - Phone:786-320-3213
Mailing Address - Fax:
Practice Address - Street 1:1839 NW FLAGLER TER APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5434
Practice Address - Country:US
Practice Address - Phone:786-320-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician