Maryknoll Antonio Ponce
Licensed Psychiatric Technician in Stockton, CA. Individual provider (NPI-1).
NPI number1649068024
StatusActive
Last updated in NPPESApr 28, 2025
Details
- NPI
- 1649068024
- Entity type
- Individual (NPI-1)
- Name
- Maryknoll Antonio Ponce
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 28, 2025
- Certification date
- Apr 27, 2025
- Last updated
- Apr 28, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 167G00000X | Licensed Psychiatric Technician | 42390 | CA | Yes |
Practice location
1212 N California StStockton, CA 95202-1552
Phone 209-468-8700
Mailing address
1212 N California StStockton, CA 95202-1552
Phone 209-468-8700
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