Individual provider Active NPI

Moises Ponce, MFT INTERN

  • Marriage & Family Therapist
  • Redlands, CA
National Provider Identifier
1760508774
Registry record updated Jan 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
52264 Issued in CA
Practice address
1809 W Redlands Blvd Ste 102
Redlands, CA 92373-8054
Phone
(909) 809-9986
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 52264 CA Primary

Addresses

Primary practice location

1809 W Redlands Blvd Ste 102
Redlands, CA 92373-8054

Mailing address

25742 Van Leuven St
Loma Linda, CA 92354-2508
Phone (909) 809-9986

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240304000772 CA Practitioner - Marriage and Family Therapist 7517302326 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1809 W Redlands Blvd
Redlands, CA 92373-8054
Phone (909) 335-3026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Inland Psychiatric Medical Group Inc Marriage & Family Therapist CurrentSince Jan 17, 2024 Accepting new patients
Inland Psychiatric Medical Group, Inc. Marriage & Family Therapist CurrentSince Jan 17, 2024 Accepting new patients
Inland Psychiatric Medical Group, Inc. Marriage & Family Therapist Current Accepting new patients

Locations

8710 Monroe Ct
Ste 150
Rancho Cucamonga, CA 91730
Phone (909) 941-4870

1809 W Redlands Blvd
Redlands, CA 92373
Phone (909) 307-1320

1809 W Redlands Blvd
Ste 102
Redlands, CA 92373
Phone (909) 809-9986

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737244800000",
    "number": "1760508774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25742 VAN LEUVEN ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542508",
            "telephone_number": "909-809-9986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 W REDLANDS BLVD STE 102",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054",
            "telephone_number": "909-809-9986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE",
        "first_name": "MOISES",
        "name_prefix": "Mr.",
        "credential": "MFT INTERN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2025-01-19",
        "certification_date": "2025-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "52264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.