Individual
CHARLES WAYNE PORTNEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2336 SANTA MONICA BLVD, #100, SANTA MONICA, CA 90404-2095
(310) 828-7870
(310) 828-9790
Mailing address
2336 SANTA MONICA BLVD, #100, SANTA MONICA, CA 90404-2095
(310) 828-7870
(310) 828-9790
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G320840
CA
Other
Enumeration date
12/13/2005
Last updated
07/08/2007
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