Provider Demographics
NPI:1134374465
Name:PONCE, CHERI LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNNE
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 1:2409 ARTESIA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3207
Mailing Address - Country:US
Mailing Address - Phone:424-276-4700
Mailing Address - Fax:424-903-1099
Practice Address - Street 1:6181 N THESTA ST STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8604
Practice Address - Country:US
Practice Address - Phone:559-825-0300
Practice Address - Fax:559-825-0301
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51641207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1084991OtherNCCPA