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General NPI Number Information
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NPI Number | 1386881258
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Entity Type | Organization
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Legal Business Name | MARY Z PONCE
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 5835 CALLAGHAN RD SUITE 322
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1125
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Country | US
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Telephone | 210-233-1566
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Fax | 210-547-7780
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Provider Business Mailing Address
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Address Line | 5835 CALLAGHAN RD SUITE 322
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1125
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Country | US
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Telephone | 210-233-1566
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Fax | 210-547-7780
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MARY ZOILA PONCE
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Credential | PSYD
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Telephone | 210-233-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 30933
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License Number State | TX
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