Provider Demographics
NPI:1861096067
Name:SONIA G PONCE CARDIOLOGY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SONIA G PONCE CARDIOLOGY A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-290-2310
Mailing Address - Street 1:340 4TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-754-9500
Mailing Address - Fax:619-489-6177
Practice Address - Street 1:227 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2702
Practice Address - Country:US
Practice Address - Phone:619-754-9500
Practice Address - Fax:619-489-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-28
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164659033OtherCARDIOLOGY
CA1164659033Medicaid