Healthcare Provider Details

I. General information

NPI: 1609617984
Provider Name (Legal Business Name): PORSHA ROCHELLE HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 S ARCHIBALD AVE STE H-1043
ONTARIO CA
91761-9001
US

IV. Provider business mailing address

16230 SEQUOIA ST APT 7
HESPERIA CA
92345-1790
US

V. Phone/Fax

Practice location:
  • Phone: 760-524-1368
  • Fax:
Mailing address:
  • Phone: 760-524-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: