Healthcare Provider Details

I. General information

NPI: 1356687347
Provider Name (Legal Business Name): JUDY PONCE LEVIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDY PONCE MOYA FNP

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S ZARZAMORA ST
SAN ANTONIO TX
78207-5209
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-7000
  • Fax:
Mailing address:
  • Phone: 210-358-5909
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number649665
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: