MEDICARE: ANDREA NICOLE PONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist		PR

General Provider Information

NPI Number	:	1093649675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA NICOLE PONS

Provider Business Mailing Address
First Line	:	10 VILLAS DE LA ESPERANZA
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-9622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE. HOSTOS #410, CARRETERA #2, BO. SABALO
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680
Country	:	US
Telephone Number	:	787-652-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ ANDREA NICOLE PONS ” Practice Location

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