Healthcare Provider Details

I. General information

NPI: 1952752354
Provider Name (Legal Business Name): FELIZARDO PONCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 SW 137TH AVE
MIAMI FL
33175-6330
US

IV. Provider business mailing address

14335 SW 120TH ST 201
MIAMI FL
33186-7294
US

V. Phone/Fax

Practice location:
  • Phone: 786-832-6630
  • Fax: 786-558-5229
Mailing address:
  • Phone: 305-967-8074
  • Fax: 305-967-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: