Organization
M. JAY PORCELLI DO A MEDICAL CORPORATION
Active
Organization
M. JAY PORCELLI DO A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN JAY PORCELLI D.O. (CEO & PRESIDENT)
(909) 620-1955
Entity
Organization
Contact information
Practice address
336 ERVILLA ST, POMONA, CA 91767-3016
(909) 620-1955
(909) 623-0720
Mailing address
336 ERVILLA ST, POMONA, CA 91767-3016
(909) 620-1955
(909) 623-0720
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
20A4403
CA
208VP0000X
Pain Medicine Physician
20A4403
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20A4403
—
CA
Enumeration date
02/27/2014
Last updated
03/11/2014
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