Provider Demographics
NPI:1770821316
Name:CAMPOS DE PONCE, MARIA ANGELICA (MSC/MFCT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:CAMPOS DE PONCE
Suffix:
Gender:F
Credentials:MSC/MFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 AIRWAY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4652
Mailing Address - Country:US
Mailing Address - Phone:714-689-1380
Mailing Address - Fax:714-689-1381
Practice Address - Street 1:1328 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2240
Practice Address - Country:US
Practice Address - Phone:310-390-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist