Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ASW 36349 | CA |
NPI | 1003256348 |
---|---|
Provider Name | Angela Ponce |
First Address | Northridge, CA 91325-2003 |
Second Address | Northridge, CA 91325-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 31/07/2013 |