Provider Demographics
NPI:1245768613
Name:PONCE DE LEON, MONICA RENEE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:PONCE DE LEON
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 1:900 STANFORD AVE APT 2408
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3602
Mailing Address - Country:US
Mailing Address - Phone:951-609-5988
Mailing Address - Fax:
Practice Address - Street 1:27076 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3662
Practice Address - Country:US
Practice Address - Phone:909-647-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst