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General NPI Number Information
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NPI Number | 1285289074
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Entity Type | Individual
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Provider Name | MICHELLE DIANE PONCE LVN
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 1260 MORENA BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92110
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Country | US
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Telephone | 619-398-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 CRAIGMONT ST
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City | EL CAJON
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State | CA
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Zip | 92019-3108
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Country | US
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Telephone | 858-437-3112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 258414
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License Number State | CA
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