Individual
MR. CHARLES PONCELET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 296-8650
Mailing address
3130 ROADRUNNER LANE, TEMPLETON, CA 93465
(805) 296-8650
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN477166
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN477166
CALIFORNIA BOARD OF REGISTERED NURSING
CA
Enumeration date
07/17/2013
Last updated
07/17/2013
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