Healthcare Provider Details

I. General information

NPI: 1053301945
Provider Name (Legal Business Name): RICHARD MICHAEL PORZIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 BESSIE AVE STE 108
TRACY CA
95376-3080
US

IV. Provider business mailing address

4301 NORTHSTAR WAY
MODESTO CA
95356-9262
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA60117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: