Individual
DIANA MARIBEL PONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7910 ATLANTIC AVE, SUITE M, LOS ANGELES, CA 90201
(323) 908-4200
(323) 432-4877
Mailing address
4425 S CENTRAL AVE, LOS ANGELES, CA 90011-3629
(323) 908-4200
(323) 432-4877
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
363A00000X
Physician Assistant
Primary
PA67478
CA
Other
Enumeration date
12/14/2022
Last updated
06/30/2026
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