# GLORIA PONCE TUA MEDICINA INTERNA CSP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184048175
- **Authorized official:** DR. GLORIA I PONCE TUA M.D. (MEDICO INTERNISTA)
- **Authorized official phone:** (787) 833-0685

## Contact information

- **Practice address:** CALLE DR BASORA NO 55N, SUITE 204D, MAYAGUEZ, PR 00680-4888
- **Practice address phone:** (787) 833-0685
- **Practice address fax:** (787) 265-2755
- **Mailing address:** CALLE DR BASORA NO 55N, SUITE 204D, MAYAGUEZ, PR 00680-4888
- **Mailing address phone:** (787) 833-0685
- **Mailing address fax:** (787) 265-2755

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 13516 | PR | Yes |

## Other

- **Enumeration date:** 02/11/2014
- **Last updated:** 08/04/2014