Provider Demographics
NPI:1356664890
Name:PONCE, TANIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 E KAISER BLVD UNIT 28864
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31720 TEMECULA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5895
Practice Address - Country:US
Practice Address - Phone:951-302-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant