Healthcare Provider Details

I. General information

NPI: 1972393536
Provider Name (Legal Business Name): BELKI PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OCEANGATE FL 10
LONG BEACH CA
90802-4316
US

IV. Provider business mailing address

28026 DRYWELL CIR
CASTAIC CA
91384-2581
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-3666
  • Fax:
Mailing address:
  • Phone: 310-696-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: