Healthcare Provider Details

I. General information

NPI: 1780011726
Provider Name (Legal Business Name): PATRICK MANLUTAC PORTIZ M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2013
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8570 W SUNSET BLVD
WEST HOLLYWOOD CA
90069-2312
US

IV. Provider business mailing address

2 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-3823
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 415-578-3100
  • Fax: 415-291-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA127477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: