Basic Information
| Provider Information | |||||||||
| NPI: | 1801081336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONCE | ||||||||
| FirstName: | NOEMY | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13151 FOUNTAIN PARK DR | ||||||||
| Address2: | APT. C402 | ||||||||
| City: | PLAYA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900942031 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1085 W VICTORIA ST | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902205804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108685379 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 22453 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.