Healthcare Provider Details

I. General information

NPI: 1902623069
Provider Name (Legal Business Name): PONDECA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26120 N POSEIDON RD
FLORENCE AZ
85132-5537
US

IV. Provider business mailing address

929 N VAL VISTA DR STE 109 PMB 1113
GILBERT AZ
85234-3701
US

V. Phone/Fax

Practice location:
  • Phone: 602-880-0133
  • Fax:
Mailing address:
  • Phone: 602-880-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISS CLARA PONDECA
Title or Position: OWNER
Credential:
Phone: 602-880-0133