Healthcare Provider Details

I. General information

NPI: 1750442208
Provider Name (Legal Business Name): MARIO RICARDO PONCE MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WEST HEDDING STREET COUNTY OF SANTA CLARA
SAN JOSE CA
95110
US

IV. Provider business mailing address

2613 BARCELLS AVE
SANTA CLARA CA
95051-5703
US

V. Phone/Fax

Practice location:
  • Phone: 408-494-1561
  • Fax: 408-494-1535
Mailing address:
  • Phone: 408-649-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number139720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: