Healthcare Provider Details

I. General information

NPI: 1386579506
Provider Name (Legal Business Name): JAQUELIN ALBOR PONCE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 300
TEMECULA CA
92591-4678
US

IV. Provider business mailing address

21253 WAITE ST
WILDOMAR CA
92595-8468
US

V. Phone/Fax

Practice location:
  • Phone: 951-466-3196
  • Fax:
Mailing address:
  • Phone: 951-399-4978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: