Provider Information for 1073238598
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Dr. JONATHAN PONCE PsyD
Sex: Male
NPI: 1073238598
Last Updated: 2023-11-22
Certification Date: 2023-07-13
Certification Date: 2023-07-13
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073238598 | ||||||||
| Enumeration Date | 2022-10-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 86-260 FARRINGTON HWY WAIANAE, HI 96792-3128 United States Phone: 808-282-6332 | Fax: | ||||||||
| Primary Practice Address | 86-260 FARRINGTON HWY WAIANAE, HI 96792-3128 United States Phone: 808-967-3300 | Fax: | ||||||||
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