Healthcare Provider Details

I. General information

NPI: 1134052418
Provider Name (Legal Business Name): LEAH PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL
AURORA CO
80045-2570
US

IV. Provider business mailing address

509 APEX RISE ST
ERIE CO
80516-9546
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-5000
  • Fax:
Mailing address:
  • Phone: 575-740-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1695433
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: