Basic Information
Provider Information | |||||||||
NPI: | 1376936187 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PONCE | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 595 CENTER AVE | ||||||||
Address2: | SUITE 300 | ||||||||
City: | MARTINEZ | ||||||||
State: | CA | ||||||||
PostalCode: | 945534633 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9253136098 | ||||||||
FaxNumber: | 9253136599 | ||||||||
Practice Location | |||||||||
Address1: | 13601 SAN PABLO AVE | ||||||||
Address2: |   | ||||||||
City: | SAN PABLO | ||||||||
State: | CA | ||||||||
PostalCode: | 948063818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5102319471 | ||||||||
FaxNumber: | 5103741090 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/18/2015 | ||||||||
LastUpdateDate: | 03/18/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP1700X | 813418 | CA | Y |   | Nursing Service Providers | Registered Nurse | Perinatal |
No ID Information.