Dr Melissa Ponce- Functional Medicine

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

DC31510 Issued in CA

Legal business name

DR MELISSA PONCE- FUNCTIONAL MEDICINE

Practice address

654 N El Camino Real
Ste. 101
San Mateo, CA 94401-3713

Phone

(650) 242-9202

NPI assigned

Oct 30, 2012

Organization subpart

No

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

Authorized official

Name

Melissa Ponce, DC

Title

Owner

Phone

(909) 260-2181

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1548514474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 N EL CAMINO REAL",
            "address_2": "STE. 101",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 N EL CAMINO REAL",
            "address_2": "STE. 101",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013713",
            "telephone_number": "650-242-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MELISSA PONCE- FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "PONCE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-260-2181",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "CA",
            "license": "DC31510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.