Individual
MR. MARTIN AMABLE PONCIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, LMFT
Contact information
Practice address
2250 SOQUEL AVE, SANTA CRUZ, CA 95062-1402
(831) 600-2800
Mailing address
225 MAIN ST # 945, WATSONVILLE, CA 95076-9998
(619) 274-1682
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
MFC 96247
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95259414
CA
Other
Enumeration date
07/12/2012
Last updated
04/24/2024
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