Individual
MRS. THERESA G PONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
202 N 8TH ST, EL CENTRO, CA 92243-2302
(760) 482-4034
Mailing address
545 WENSLEY AVE, EL CENTRO, CA 92243-3954
(760) 353-8910
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 26962
CA
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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