Active NPI
John Ponzo
- Professional Counselor
- San Diego, CA
National Provider Identifier
1356575989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 13312
- Practice address
- 3255 Camino del Rio S
San Diego, CA 92108-3806 - Phone
- (619) 894-4959
- NPI assigned
- May 11, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH11030 | WA | |
| Professional Counselor | 101YP2500X | 13312 | CA | Primary |
Addresses
Primary practice location
3255 Camino del Rio S
San Diego, CA 92108-3806
Mailing address
3255 Camino del Rio S
San Diego, CA 92108-3806
Phone (619) 894-4959
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 |
|---|---|---|---|
| LH11030 | WA | MD | Mental Health Counselor |
| 13312 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1356575989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3255 CAMINO DEL RIO S",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083806",
"telephone_number": "619-894-4959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3255 CAMINO DEL RIO S",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083806",
"telephone_number": "619-894-4959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONZO",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-11",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH11030",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "13312",
"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 May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.