Provider Demographics
NPI:1184216160
Name:PONCE DE LEON, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PONCE DE LEON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MARATHON DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0918
Mailing Address - Country:US
Mailing Address - Phone:408-866-2027
Mailing Address - Fax:408-866-0302
Practice Address - Street 1:420 MARATHON DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0918
Practice Address - Country:US
Practice Address - Phone:408-866-2027
Practice Address - Fax:408-866-0302
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor