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General NPI Number Information
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NPI Number | 1154025351
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Entity Type | Individual
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Provider Name | RAUL PONCE
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Gender | Male
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 14707 S DIXIE HWY STE 200
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City | PALMETTO BAY
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State | FL
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Zip | 33176-7950
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Country | US
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Telephone | 786-592-1574
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Fax | 305-489-5972
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Provider Business Mailing Address
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Address Line | 14707 S DIXIE HWY STE 200
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City | PALMETTO BAY
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State | FL
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Zip | 33176-7950
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Country | US
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Telephone | 786-592-1574
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Fax | 305-489-5972
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-75714
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License Number State | FL
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