MEDICARE: LINDA MARIE PONZI BSRT(R)CTARRT, CFMHC

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
1	171400000X	Health & Wellness Coach
2	247100000X	Radiologic Technologist	217180

General Provider Information

NPI Number	:	1932906922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA MARIE PONZI BSRT(R)CTARRT, CFMHC

Provider Business Mailing Address
First Line	:	2736 HIGH RANGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-7566
Country	:	US
Telephone Number	:	415-699-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 HIGH RANGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-7566
Country	:	US
Telephone Number	:	415-699-0133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/26/2025

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