Healthcare Provider Details

I. General information

NPI: 1508790791
Provider Name (Legal Business Name): MARISOL PONTE ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5143 SW 157TH CT
MIAMI FL
33185-5017
US

IV. Provider business mailing address

5143 SW 157TH CT
MIAMI FL
33185-5017
US

V. Phone/Fax

Practice location:
  • Phone: 786-340-7284
  • Fax: 305-482-6977
Mailing address:
  • Phone: 786-340-7284
  • Fax: 305-482-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: