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General NPI Number Information
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NPI Number | 1427105626
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Entity Type | Individual
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Provider Name | JOSE ENRIQUE PONCE N.P.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1321 NW 13TH ST PRE-TRIAL DETENTION CENTER, CORRECTIONS HEALTH SERVICES
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City | MIAMI
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State | FL
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Zip | 33125-1603
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Country | US
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Telephone | 786-263-4120
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Fax | 305-545-4042
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Provider Business Mailing Address
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Address Line | 6331 HUTCHINSON RD
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2301
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Country | US
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Telephone | 305-819-6495
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1375412
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License Number State | FL
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