Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1063184992 |
---|---|
Provider Name | Riley Elizabeth Porter |
First Address | Alpine, CA 91901-2113 |
Second Address | Alpine, CA 91901-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2021 |
Last Update Date | 29/09/2021 |