Healthcare Provider Details

I. General information

NPI: 1750716924
Provider Name (Legal Business Name): ASHLEY PORTEOUS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY BALLARD

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

560 BOYD RD
PLEASANT HILL CA
94523-3245
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: