Ponciano Wellness, Llc | |
5212 Katella Ave Suite 202 Los Alamitos CA 90720-2828 | |
(888) 568-5640 | |
(562) 493-0922 |
Full Name | Ponciano Wellness, Llc |
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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 |
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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 |
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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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