Healthcare Provider Details

I. General information

NPI: 1568658730
Provider Name (Legal Business Name): ANNA LEE PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N MAIN ST
ALTURAS CA
96101-3457
US

IV. Provider business mailing address

441 N MAIN ST
ALTURAS CA
96101-3457
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-6312
  • Fax: 530-233-5311
Mailing address:
  • Phone: 530-233-6312
  • Fax: 530-233-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: