Healthcare Provider Details

I. General information

NPI: 1013004563
Provider Name (Legal Business Name): FELICIA RENE' PONCE MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5974 PENTZ RD
PARADISE CA
95969-5509
US

IV. Provider business mailing address

2068 TALBERT DR STE 150
CHICO CA
95928-7741
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-9361
  • Fax: 530-867-7943
Mailing address:
  • Phone: 530-809-0009
  • Fax: 530-809-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number974248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: