Healthcare Provider Details

I. General information

NPI: 1124109236
Provider Name (Legal Business Name): PATRICK GERARD PORTER RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

317 FOULKSTONE WAY
VALLEJO CA
94591-7248
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-4640
  • Fax: 310-268-4568
Mailing address:
  • Phone: 415-377-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number00022871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: