Provider Demographics
NPI:1770821316
Name:CAMPOS DE PONCE, MARIA ANGELICA (MSC/MFCT, LMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:CAMPOS DE PONCE
Suffix:
Gender:F
Credentials:MSC/MFCT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3319
Mailing Address - Country:US
Mailing Address - Phone:949-531-1946
Mailing Address - Fax:
Practice Address - Street 1:2220 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3319
Practice Address - Country:US
Practice Address - Phone:949-531-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA117030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA117030OtherBBS