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General NPI Number Information
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NPI Number | 1245430172
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Entity Type | Individual
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Provider Name | NANCY A PORTER-BASS RDHAP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 25481 DODGE AVE. BLDG. #3
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City | HARBOR CITY
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State | CA
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Zip | 90710-3140
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Country | US
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Telephone | 323-556-1453
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Fax |
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Provider Business Mailing Address
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Address Line | 25481 DODGE AVE BDLG. #3
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City | HARBOR CITY
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State | CA
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Zip | 90710-3130
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Country | US
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Telephone | 323-556-1453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 191
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License Number State | CA
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