Individual
JEREMY J PORTJE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3270 KERNER BLVD STE C, SAN RAFAEL, CA 94901-4840
(415) 960-8290
Mailing address
55 HILLSIDE TER, NOVATO, CA 94945-3509
(415) 960-8290
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-WIBDCJ
CA
Other
Enumeration date
06/17/2025
Last updated
06/17/2025
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