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General NPI Number Information
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NPI Number | 1083485213
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Entity Type | Individual
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Provider Name | HECTOR ANIBAL PONCE SR. AGNP
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Gender | Male
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 3900 E LOHMAN AVE STE B
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City | LAS CRUCES
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State | NM
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Zip | 88011-8268
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Country | US
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Telephone | 575-522-5752
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Fax | 575-522-5722
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Provider Business Mailing Address
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Address Line | 12848 TIERRA PUEBLO
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City | EL PASO
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State | TX
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Zip | 79938-4303
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Country | US
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Telephone | 915-217-6585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 77261
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License Number State | NM
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