Healthcare Provider Details

I. General information

NPI: 1972413037
Provider Name (Legal Business Name): NAEDINE PONCE BACIERTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 S HARBOR BLVD
ANAHEIM CA
92802-2309
US

IV. Provider business mailing address

1313 S HARBOR BLVD
ANAHEIM CA
92802-2309
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-8840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number311076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: