Individual
LIDIA PORTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6559 W PINNACLE PEAK RD, GLENDALE, AZ 85310-3415
(623) 376-6134
Mailing address
6559 W PINNACLE PEAK RD, GLENDALE, AZ 85310-3415
(623) 376-6134
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
ALH-6526
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALH-6526
AZ DHS
AZ
Enumeration date
02/13/2008
Last updated
02/13/2008
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