Healthcare Provider Details

I. General information

NPI: 1588329825
Provider Name (Legal Business Name): ORIN L. PORTER SR. RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 GREEN VALLEY CIR
CULVER CITY CA
90230-7068
US

IV. Provider business mailing address

6666 GREEN VALLEY CIR
CULVER CITY CA
90230-7068
US

V. Phone/Fax

Practice location:
  • Phone: 310-305-8878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: