Provider Demographics
NPI:1902623069
Name:PONDECA CONSULTANTS
Entity type:Organization
Organization Name:PONDECA CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONDECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-880-0133
Mailing Address - Street 1:2303 N 44TH ST STE 14-1043
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-2442
Mailing Address - Country:US
Mailing Address - Phone:602-880-0133
Mailing Address - Fax:
Practice Address - Street 1:2303 N 44TH ST STE 14-1043
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2442
Practice Address - Country:US
Practice Address - Phone:602-880-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty