Healthcare Provider Details

I. General information

NPI: 1578406385
Provider Name (Legal Business Name): BERTHA PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S PROSPECTORS RD STE I
DIAMOND BAR CA
91765-1618
US

IV. Provider business mailing address

1876 FLEMING ST
POMONA CA
91766-1027
US

V. Phone/Fax

Practice location:
  • Phone: 909-922-2497
  • Fax:
Mailing address:
  • Phone: 909-235-0146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: