Healthcare Provider Details

I. General information

NPI: 1952827271
Provider Name (Legal Business Name): KAREN ARACELI PONCE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

9660 MAGNOLIA ST
BLOOMINGTON CA
92316-1438
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-7270
  • Fax:
Mailing address:
  • Phone: 818-614-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number312022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: