Healthcare Provider Details

I. General information

NPI: 1871030858
Provider Name (Legal Business Name): MICHELLE PORCIUNCULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8345 RESEDA BLVD STE 209
NORTHRIDGE CA
91324-5941
US

IV. Provider business mailing address

8345 RESEDA BLVD STE 209
NORTHRIDGE CA
91324-5941
US

V. Phone/Fax

Practice location:
  • Phone: 818-433-0262
  • Fax:
Mailing address:
  • Phone: 818-433-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number804875
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: