Individual
DIANA MARIBEL PONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2602 VALLEJO ST, LOS ANGELES, CA 90031-3032
(323) 332-8149
Mailing address
2602 VALLEJO ST, LOS ANGELES, CA 90031-3032
(323) 332-8149
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
02/13/2026
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