Active NPI
Aniel Ponce
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1205281193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33407
- Practice address
- 11650 Iberia PL Ste 130
San Diego, CA 92128-2431 - Phone
- (858) 264-5858
- Fax
- (858) 649-6012
- NPI assigned
- Apr 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 33407 | CA | Primary |
Addresses
Primary practice location
11650 Iberia PL Ste 130
San Diego, CA 92128-2431
Mailing address
PO Box 8488
Pasadena, CA 91109-8607
Phone (858) 264-5858
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33407 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655164800000",
"number": "1205281193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8488",
"city": "PASADENA",
"state": "CA",
"postal_code": "911098607",
"telephone_number": "858-264-5858",
"fax_number": "858-649-6012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11650 IBERIA PL STE 130",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921282431",
"telephone_number": "858-264-5858",
"fax_number": "858-649-6012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONCE",
"first_name": "ANIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-27",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "33407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.