MEDICARE: ELFEGO NICHOLAS PONCE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	858085	TX

General Provider Information

NPI Number	:	1609708999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELFEGO NICHOLAS PONCE CRNA

Provider Business Mailing Address
First Line	:	1012 LARRIWOOD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-4715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 N WASHINGTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89191-7085
Country	:	US
Telephone Number	:	830-765-4141
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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