Provider Demographics
NPI:1013004563
Name:PONCE, FELICIA RENE' (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:RENE'
Last Name:PONCE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 TALBERT DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7741
Mailing Address - Country:US
Mailing Address - Phone:530-809-0009
Mailing Address - Fax:530-809-0399
Practice Address - Street 1:5974 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5509
Practice Address - Country:US
Practice Address - Phone:530-877-9361
Practice Address - Fax:530-867-7943
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA974248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03535ZMedicare ID - Type UnspecifiedREGISTERED DIETITIAN