Provider Demographics
NPI:1932750643
Name:PONCE, JANIE ELIZABETH
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:ELIZABETH
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 MONTECITO WAY
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-1624
Mailing Address - Country:US
Mailing Address - Phone:760-315-7457
Mailing Address - Fax:
Practice Address - Street 1:16303 SCARBERY RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4249
Practice Address - Country:US
Practice Address - Phone:760-788-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS0937242OtherDRIVER LICENSE