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General NPI Number Information
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NPI Number | 1750347159
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Entity Type | Individual
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Provider Name | MARC J POROT MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 515 S VAN NESS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90020-4616
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Country | US
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Telephone | 213-493-2086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A42809
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A42809
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License Number State | CA
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