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NPI Code Detail

MEDICARE: ANIEL PONCE

MEDICARE: ANIEL PONCE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist33407CA

General Provider Information

NPI Number : 1205281193
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANIEL PONCE
Provider Business Mailing Address
First Line : PO BOX 8488
Second Line :
City : PASADENA
State : CA
Zip : 91109-8607
Country : US
Telephone Number : 858-264-5858
Fax Number : 858-649-6012
Provider Business Practice Location Address
First Line : 11650 IBERIA PL STE 130
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-2431
Country : US
Telephone Number : 858-264-5858
Fax Number : 858-649-6012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2016
Last Update Date : 06/14/2022

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Directions to “ ANIEL PONCE ” Practice Location

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