Jeffery Ponce

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

P0412282013 Issued in CA

Practice address

4510 Peralta Blvd
Suite 1
Fremont, CA 94536-5755

Phone

(510) 713-3202

Fax

(510) 713-0684

NPI assigned

Oct 12, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1295923357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 PERALTA BLVD",
            "address_2": "SUITE 1",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945365755",
            "telephone_number": "510-713-3202",
            "fax_number": "510-713-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 PERALTA BLVD",
            "address_2": "SUITE 1",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945365755",
            "telephone_number": "510-713-3202",
            "fax_number": "510-713-0684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE",
        "first_name": "JEFFERY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-12",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "P0412282013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCAPP",
            "identifier": "CO53190518",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BREINING INSTITUTE",
            "identifier": "P0412282013",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Douglas Poechhacker
• Monika Pointer
• Chesna Pokharel
• Katy Polony
• Adelisa Ponce
• Preslli Celine Ponce
• Vimala Meghana Ponna Suri, DO
• Swathi Ponugoti, DDS
• Mimy Poon
• Camille Porteous

• Addiction (Substance Use Disorder) Counselor in Fremont, CA
• Providers in Fremont, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.