Healthcare Provider Details

I. General information

NPI: 1457271868
Provider Name (Legal Business Name): MARICELA PONCE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S HUDSON AVE # 130
PASADENA CA
91101-3507
US

IV. Provider business mailing address

11125 BASYE ST APT A
EL MONTE CA
91731-1672
US

V. Phone/Fax

Practice location:
  • Phone: 831-221-6093
  • Fax:
Mailing address:
  • Phone: 626-417-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: