Individual
AMY C. PORTMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 INDUSTRIAL RD, SAN CARLOS, CA 94070
(650) 596-4000
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(650) 596-4000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G79688
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G796880
BLUE SHIELD PIN
CA
01
—
00G96880
ZURICH PIN
CA
01
—
4600644
AETNA PIN
CA
Enumeration date
01/08/2007
Last updated
06/04/2020
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