Basic Information
| Provider Information | |||||||||
| NPI: | 1710172648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PONCE | ||||||||
| FirstName: | FRANCES CATHERINE | ||||||||
| MiddleName: | VICENCIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PONCE | ||||||||
| OtherFirstName: | FRANCES | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1993 ERRECART BLVD | ||||||||
| Address2: | GOLDEN HEALTH FAMILY MEDICAL CLINIC | ||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898018334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757531049 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1993 ERRECART BLVD | ||||||||
| Address2: | GOLDEN HEALTH FAMILY MEDICAL CLINIC | ||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898018334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757531049 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 01/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 12901 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1710172648 | 05 | NV | MEDICAID |