Basic Information
| Provider Information | |||||||||
| NPI: | 1659581189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONCE | ||||||||
| FirstName: | ANGEL | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | R. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 N FINE STE #116 | ||||||||
| Address2: | HUMAN RESOURCES | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575231 | ||||||||
| FaxNumber: | 5594575896 | ||||||||
| Practice Location | |||||||||
| Address1: | 2790 S ELM AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937065435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1006X | 88276 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.