Healthcare Provider Details

I. General information

NPI: 1902734221
Provider Name (Legal Business Name): KATRINA MARIE PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 TRAFFIC WAY
ATASCADERO CA
93422-4253
US

IV. Provider business mailing address

7343 EL CAMINO REAL # 147
ATASCADERO CA
93422-4697
US

V. Phone/Fax

Practice location:
  • Phone: 805-287-0006
  • Fax:
Mailing address:
  • Phone: 805-287-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number44767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: