Individual
MISS VONDRA CARLOTTA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
11318 VENTURA BLVD, STUDIO CITY, CA 91604-3137
(818) 761-3988
Mailing address
618 N VALLEY ST, BURBANK, CA 91505-3147
(818) 919-2256
(818) 563-6630
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
0002333277-0001-9 LA
CA
Other
Enumeration date
02/11/2009
Last updated
02/11/2009
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