Georgina Comin Ponce de Leon, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00042005 Issued in WA

Practice address

Madigan Army Medical Center 9040 Jackson Avenue
Tacoma, WA 98431-1100

Phone

(253) 968-2252

Fax

(253) 968-3278

NPI assigned

Aug 20, 2006

Last updated

Dec 31, 2019By the provider in NPPES

Sex

Female

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1588779284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CTR",
            "address_2": "9040 REID STREET, ATTN: MCHJ-CLQ-C",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984311100",
            "telephone_number": "253-968-2252",
            "fax_number": "253-968-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENUE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984311100",
            "telephone_number": "253-968-2252",
            "fax_number": "253-968-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE DE LEON",
        "first_name": "GEORGINA",
        "middle_name": "COMIN",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00042005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Alan Polo, M.D.
• Kathleen B Polo, MD
• Vladislav Polyakov, M.D.
• Amberkiah L Pomeroy, AU.D
• Janet Pomeroy, MSW, LSWAIC, CMC
• Marcus C Ponce de Leon, M.D.
• Mario Natale Ponticello, DPM
• Justin Pool, PSY.D.
• Lorraine Phillips Poole
• Susan Janette Poole, PH.D.

• Pediatrics Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.