Provider Demographics
NPI:1326238791
Name:PONCE, FRANCISCO Q IV (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:Q
Last Name:PONCE
Suffix:IV
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3747
Mailing Address - Country:US
Mailing Address - Phone:831-722-9195
Mailing Address - Fax:
Practice Address - Street 1:1150 MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3747
Practice Address - Country:US
Practice Address - Phone:831-722-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11841103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist