NPI |
1093274441 |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Entity Type Code |
1 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Last Name Legal Name |
PONCE |
Other name by which the organization provider is or has been known. |
Provider First Name |
ASHLEY |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider Middle Name |
ANGIE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider First Line Business Practice Location Address |
5558 CALIFORNIA AVE STE 340 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BAKERSFIELD |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
933090710 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
6613261577 |
The country code in the location address of the provider being identified. |
Provider Enumeration Date |
3/15/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/6/2022 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
103K00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
10/6/2022 |
|