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NPI Code Detail

MEDICARE: DR. FERNANDA SAMIRA PONCE MD

MEDICARE: DR. FERNANDA SAMIRA PONCE MD
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
1207R00000XInternal Medicine Physician69878CT
2207R00000XInternal Medicine PhysicianME156325FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194285486
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FERNANDA SAMIRA PONCE MD
Provider Business Mailing Address
First Line : 8750 SW 144TH ST STE 100
Second Line :
City : PALMETTO BAY
State : FL
Zip : 33176-7229
Country : US
Telephone Number : 786-596-3840
Fax Number :
Provider Business Practice Location Address
First Line : 8750 SW 144TH ST STE 100
Second Line :
City : PALMETTO BAY
State : FL
Zip : 33176-7229
Country : US
Telephone Number : 786-596-3840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2019
Last Update Date : 04/08/2023

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