Provider Demographics
NPI:1942926290
Name:PONZIO, NANCY (COTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PONZIO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17333 VALLEY BLVD SPC 70E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6875
Mailing Address - Country:US
Mailing Address - Phone:909-997-2012
Mailing Address - Fax:
Practice Address - Street 1:9631 MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2233
Practice Address - Country:US
Practice Address - Phone:909-802-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401231224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant