Healthcare Provider Details

I. General information

NPI: 1902722523
Provider Name (Legal Business Name): THAMYRES PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 TOWN CENTRE DR
MEDFORD OR
97504-6190
US

IV. Provider business mailing address

945 TOWN CENTRE DR
MEDFORD OR
97504-6190
US

V. Phone/Fax

Practice location:
  • Phone: 541-362-9933
  • Fax: 413-629-9944
Mailing address:
  • Phone: 541-362-9933
  • Fax: 413-629-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: