Individual
ALEXZANDER PONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
509 W 10TH ST, ANTIOCH, CA 94509-1653
(650) 270-0468
Mailing address
509 W 10TH ST, ANTIOCH, CA 94509-1653
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSB94026260
CA
103TC1900X
Counseling Psychologist
Primary
PSB94026260
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/10/2020
Last updated
12/02/2024
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