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General NPI Number Information
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NPI Number | 1750428819
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Entity Type | Individual
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Provider Name | MIGUEL PONCE CNP
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/18/2023
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Provider Practice Location Address
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Address Line | 150 N ROADRUNNER PKWY
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City | LAS CRUCES
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State | NM
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Zip | 88011-7044
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Country | US
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Telephone | 575-556-6440
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Fax | 575-556-6445
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Provider Business Mailing Address
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Address Line | 1009 CALLE PARQUE DR
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City | EL PASO
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State | TX
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Zip | 79912-7502
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Country | US
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Telephone | 915-241-6867
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 66710
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 241536
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1071475
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 66710
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 66710
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License Number State | NM
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