MEDICARE: CRYSTAL PONCE

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	1041C0700X	Clinical Social Worker	11119M	NV

General Provider Information

NPI Number	:	1174968762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL PONCE

Provider Business Mailing Address
First Line	:	1316 W ADAMS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2842
Country	:	US
Telephone Number	:	702-981-2095
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 E OWENS AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-7034
Country	:	US
Telephone Number	:	702-331-5983
Fax Number	:

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	04/09/2024

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Directions to “ CRYSTAL PONCE ” Practice Location

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