Individual
MRS. VICKI MARIE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L. P. T.
Contact information
Practice address
2731 NUGGET AVE., LAKE ISABELLA, CA 93240-2632
(760) 379-3412
(760) 379-1364
Mailing address
PO BOX 2632, LAKE ISABELLA, CA 93240-2632
(760) 379-3412
(760) 379-1364
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 30178
CA
Other
Enumeration date
02/22/2007
Last updated
07/08/2007
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