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Individual

MACK PORTER JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
10802 COLLEGE PL, CERRITOS, CA 90703-1579
(562) 924-9581
Mailing address
10802 COLLEGE PL, CERRITOS, CA 90703-1579
(562) 924-9581

Taxonomy

Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
437831
CA

Other

Enumeration date
06/21/2019
Last updated
06/21/2019
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