Provider Demographics
NPI:1952012726
Name:LIMA PONCE, NALLELY
Entity Type:Individual
Prefix:MRS
First Name:NALLELY
Middle Name:
Last Name:LIMA 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 1:868 HAWAII AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1524
Mailing Address - Country:US
Mailing Address - Phone:619-518-5106
Mailing Address - Fax:
Practice Address - Street 1:868 HAWAII AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1524
Practice Address - Country:US
Practice Address - Phone:619-518-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician