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General NPI Number Information
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NPI Number | 1932221561
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Entity Type | Individual
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Provider Name | IDAYLIS MORONO PONCE PHYSICIAN/MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 8352 SW 40 STREET
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City | MIAMI
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State | FL
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Zip | 33155-3354
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Country | US
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Telephone | 305-225-0707
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Fax | 888-208-1644
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Provider Business Mailing Address
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Address Line | 8352 SW 40 STREET
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City | MIAMI
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State | FL
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Zip | 33155-3354
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Country | US
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Telephone | 305-225-0707
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Fax | 888-208-1644
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME102072
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License Number State | FL
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