MEDICARE: MARY Z 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	251S00000X	Community/Behavioral Health Agency	30933	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1386881258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY Z PONCE

Provider Business Mailing Address
First Line	:	5835 CALLAGHAN RD
Second Line	:	SUITE 322
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1125
Country	:	US
Telephone Number	:	210-233-1566
Fax Number	:	210-547-7780

Provider Business Practice Location Address
First Line	:	5835 CALLAGHAN RD
Second Line	:	SUITE 322
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1125
Country	:	US
Telephone Number	:	210-233-1566
Fax Number	:	210-547-7780

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. MARY ZOILA PONCE
Credential	:	PSYD
Telephone Number	:	210-233-1566

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	09/15/2014

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Directions to “MARY Z PONCE ” Practice Location

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