Healthcare Provider Details

I. General information

NPI: 1225663719
Provider Name (Legal Business Name): YOSIT PONCE GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-5586
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY CREDENTIALING SERVICES
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-1800
  • Fax:
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberW9456
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: