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NPI Code Detail

MEDICARE: AIME ANDREA PONCHO

MEDICARE: AIME ANDREA PONCHO
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1457869604
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIME ANDREA PONCHO
Provider Business Mailing Address
First Line : 455 E 6TH ST
Second Line :
City : MESA
State : AZ
Zip : 85203-7118
Country : US
Telephone Number : 248-436-4400
Fax Number :
Provider Business Practice Location Address
First Line : 455 E 6TH ST
Second Line :
City : MESA
State : AZ
Zip : 85203-7118
Country : US
Telephone Number : 248-436-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2018
Last Update Date : 03/13/2025

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Directions to “ AIME ANDREA PONCHO ” Practice Location

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