Healthcare Provider Details

I. General information

NPI: 1548196322
Provider Name (Legal Business Name): PORTICO LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15460 PALOS VERDES DR
MONTE SERENO CA
95030-3235
US

IV. Provider business mailing address

15460 PALOS VERDES DR
MONTE SERENO CA
95030-3235
US

V. Phone/Fax

Practice location:
  • Phone: 408-892-3377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABHIJIT POL
Title or Position: FOUNDER & CEO
Credential:
Phone: 408-892-3377