Provider Demographics
NPI:1356011530
Name:PONCE, DANIELA SANTIAGO
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:SANTIAGO
Last Name:PONCE
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 1:370 CRENSHAW BLVD STE E100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1728
Mailing Address - Country:US
Mailing Address - Phone:310-787-1500
Mailing Address - Fax:
Practice Address - Street 1:370 CRENSHAW BLVD STE E100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1728
Practice Address - Country:US
Practice Address - Phone:310-787-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner