1356509053 NPI number — MS. VICTORIA MICHELLE PORTANIER MFT

Table of content: MS. VICTORIA MICHELLE PORTANIER MFT (NPI 1356509053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356509053 NPI number — MS. VICTORIA MICHELLE PORTANIER MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTANIER
Provider First Name:
VICTORIA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356509053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 QUAILCREST DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-416-8832
Provider Business Mailing Address Fax Number:
925-370-6504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 MAIN STREET
Provider Second Line Business Practice Location Address:
#207
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-416-8832
Provider Business Practice Location Address Fax Number:
925-370-6504
Provider Enumeration Date:
05/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 45105 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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