MEDICARE: TERESA LOUISE PONIKVAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1548996622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LOUISE PONIKVAR

Provider Business Mailing Address
First Line	:	PO BOX 3964
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95150-3964
Country	:	US
Telephone Number	:	408-896-5087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 EL CAMINO REAL # 907
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-4051
Country	:	US
Telephone Number	:	408-493-5289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	03/11/2026

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Directions to “ TERESA LOUISE PONIKVAR ” Practice Location

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