Individual
CARIDAD PONCE MARTINEZ
Active
Individual
CARIDAD PONCE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
265858
MA
2084P0800X
Psychiatry Physician
54141
CT
2084P0802X
Addiction Psychiatry Physician
54141
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004041000
MEDICAID ACCESS CENTER
CT
01
—
004082260
LEGION MEDICAID
CT
01
—
004217099
MEDICAID PCS LONG WHARF
CT
01
—
008001325
LEGION MEDICAID
CT
01
—
008003745
MEDICAID ACCESS CENTER
CT
01
—
008022622
LEGION MEDICAID
CT
05
—
110114551A
—
MA
01
—
D400249296
PONCE MARTINEZ MEDICARE
CT
01
—
S400316833
MEDICARE
MA
Enumeration date
04/18/2011
Last updated
10/27/2020
Update your record
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