Nickolas Vincent Ponce, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

162 1St St BLDG 1402
Port Hueneme, CA 93043-4316

Phone

(805) 982-6320

NPI assigned

Sep 10, 2017

Last updated

Sep 10, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505001600000",
    "number": "1265951305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5585 GLOUCESTER WAY",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 1ST ST BLDG 1402",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930434316",
            "telephone_number": "805-982-6320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE",
        "first_name": "NICKOLAS",
        "middle_name": "VINCENT",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-10",
        "last_updated": "2017-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Donald Wayne Rollins, OD

• Independent Duty Corpsman in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.