Provider Demographics
NPI:1437925260
Name:PONCE, ROCHELLE KARA MARINDA
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE KARA
Middle Name:MARINDA
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 1:3862 YALE WAY
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-3658
Mailing Address - Country:US
Mailing Address - Phone:925-980-6088
Mailing Address - Fax:
Practice Address - Street 1:3862 YALE WAY
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-3658
Practice Address - Country:US
Practice Address - Phone:925-980-6088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician