Provider Demographics
NPI:1043511843
Name:PONCE, LILIANA M
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:M
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:M
Other - Last Name:PANDURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 RED ALDER PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-1886
Mailing Address - Country:US
Mailing Address - Phone:702-232-1445
Mailing Address - Fax:
Practice Address - Street 1:737 RED ALDER PL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-1886
Practice Address - Country:US
Practice Address - Phone:702-232-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA909901041C0700X
CA112415104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical