Healthcare Provider Details

I. General information

NPI: 1780843482
Provider Name (Legal Business Name): SARAH PONCE RN MSN CNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 VIA VIS APT#93
MONTEBELLO CA
90640-3853
US

IV. Provider business mailing address

205 VIA VISTA
MONTEBELLO CA
90640
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-6701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number558750
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number15304
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number2164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: