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General NPI Number Information
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NPI Number | 1750442208
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Entity Type | Individual
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Provider Name | MARIO RICARDO PONCE MA, LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 70 WEST HEDDING STREET COUNTY OF SANTA CLARA
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City | SAN JOSE
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State | CA
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Zip | 95110
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Country | US
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Telephone | 408-494-1561
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Fax | 408-494-1535
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Provider Business Mailing Address
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Address Line | 2613 BARCELLS AVE
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City | SANTA CLARA
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State | CA
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Zip | 95051-5703
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Country | US
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Telephone | 408-649-1251
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 139720
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License Number State | CA
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