Healthcare Provider Details

I. General information

NPI: 1649858069
Provider Name (Legal Business Name): JASSARETH ALANIS PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 UNIVERSITY AVE
LA MESA CA
91942-0500
US

IV. Provider business mailing address

2329 E 126TH ST
COMPTON CA
90222-1505
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-0434
  • Fax:
Mailing address:
  • Phone: 310-714-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: