| Ponciano Wellness, Llc | |
|
5212 Katella Ave Suite 202 Los Alamitos CA 90720-2828 | |
| (888) 568-5640 | |
| (562) 493-0922 |
| Full Name | Ponciano Wellness, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 5212 Katella Ave, Los Alamitos, California |
| Authorized Official Name and Position | Roxana Lambdin (OPERATING MANAGER/ PROVIDER) |
| Authorized Official Contact | 8885685640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponciano Wellness, Llc 5212 Katella Ave Suite 202 Los Alamitos CA 90720-2828 Ph: (888) 568-5640 | Ponciano Wellness, Llc 5212 Katella Ave Suite 202 Los Alamitos CA 90720-2828 Ph: (888) 568-5640 |
| NPI Number | 1790077543 |
|---|---|
| Provider Enumeration Date | 05/12/2011 |
| Last Update Date | 05/12/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790077543 | NPI | - | NPPES |
| 1326094442 | Other | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY15130 (California) | Primary |
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