Organization
KELLY PORTNOFF, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN E OFFORD (OFFICE MANAGER)
(949) 364-5119
Entity
Organization
Contact information
Practice address
25411 CABOT RD, SUITE 109, LAGUNA HILLS, CA 92653-5520
(949) 364-5119
(949) 364-1265
Mailing address
25411 CABOT RD, SUITE 109, LAGUNA HILLS, CA 92653-5520
(949) 364-5119
(949) 364-1265
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
A067472
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WA67472G
MEDICARE PPIN
CA
Enumeration date
12/17/2008
Last updated
12/17/2008
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