Active NPI
Angela McNeilly Poncelas, MPT
- Physical Therapist
- Vallejo, CA
National Provider Identifier
1811069123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 27223
- Practice address
- 1761 Broadway St
Suite 210
Vallejo, CA 94589-2226 - Phone
- (707) 645-2563
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 27223 | CA | Primary |
Addresses
Primary practice location
1761 Broadway St
Suite 210
Vallejo, CA 94589-2226
Mailing address
1761 Broadway St
Suite 210
Vallejo, CA 94589-2226
Phone (707) 645-2563
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 |
|---|---|---|---|
| 27223 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640044800000",
"number": "1811069123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1761 BROADWAY ST",
"address_2": "SUITE 210",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892226",
"telephone_number": "707-645-2563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1761 BROADWAY ST",
"address_2": "SUITE 210",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892226",
"telephone_number": "707-645-2563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONCELAS",
"first_name": "ANGELA",
"middle_name": "MCNEILLY",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-14",
"last_updated": "2021-12-21",
"certification_date": "2021-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "27223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.