Healthcare Provider Details

I. General information

NPI: 1851985287
Provider Name (Legal Business Name): ROXANA PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14220 KENDALE LAKES BLVD
KENDALL FL
33183-3923
US

IV. Provider business mailing address

14220 KENDALE LAKES BLVD
KENDALL FL
33183-3923
US

V. Phone/Fax

Practice location:
  • Phone: 786-370-7174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-119423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: