MEDICARE: BELKI PONCE

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	363LF0000X	Family Nurse Practitioner	95031628	CA

General Provider Information

NPI Number	:	1972393536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BELKI PONCE

Provider Business Mailing Address
First Line	:	28026 DRYWELL CIR
Second Line	:
City	:	CASTAIC
State	:	CA
Zip	:	91384-2581
Country	:	US
Telephone Number	:	310-696-1531
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 OCEANGATE FL 10
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4316
Country	:	US
Telephone Number	:	562-435-3666
Fax Number	:

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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Directions to “ BELKI PONCE ” Practice Location

Language	Start Address	Practice Location

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