Healthcare Provider Details

I. General information

NPI: 1932906922
Provider Name (Legal Business Name): LINDA MARIE PONZI BSRT(R)CTARRT, CFMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 HIGH RANGE DR
LAS VEGAS NV
89134-7566
US

IV. Provider business mailing address

2736 HIGH RANGE DR
LAS VEGAS NV
89134-7566
US

V. Phone/Fax

Practice location:
  • Phone: 415-699-0133
  • Fax:
Mailing address:
  • Phone: 415-699-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number217180
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: