Provider Demographics
NPI:1174926117
Name:PONOMAROFF, MELISSA GUADALUPE (BA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:GUADALUPE
Last Name:PONOMAROFF
Suffix:
Gender:F
Credentials:BA
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Other - Middle Name:
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Mailing Address - Street 1:1255 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8750
Mailing Address - Country:US
Mailing Address - Phone:805-781-3535
Mailing Address - Fax:805-503-6499
Practice Address - Street 1:1255 KENDALL RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8750
Practice Address - Country:US
Practice Address - Phone:805-781-3535
Practice Address - Fax:805-503-6499
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator