Healthcare Provider Details

I. General information

NPI: 1720837925
Provider Name (Legal Business Name): JENNIFER PONCE EICHOLTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

IV. Provider business mailing address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4783
  • Fax: 661-266-1210
Mailing address:
  • Phone: 661-266-4783
  • Fax: 661-266-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: