Provider Demographics
NPI:1225399868
Name:PONCE, CHRISTINA L (CMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:PONCE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3764 ALICIA ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4802
Mailing Address - Country:US
Mailing Address - Phone:714-588-3363
Mailing Address - Fax:
Practice Address - Street 1:18200 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4056
Practice Address - Country:US
Practice Address - Phone:714-646-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAMCT 8567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist