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NPI Code Detail

MEDICARE: AMBER LAQUITA PORTIS

MEDICARE: AMBER LAQUITA PORTIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistCA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1003393075
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER LAQUITA PORTIS
Provider Business Mailing Address
First Line : 1500 S HAVEN AVE STE 250
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2973
Country : US
Telephone Number : 909-749-5204
Fax Number : 909-217-3456
Provider Business Practice Location Address
First Line : 1500 S HAVEN AVE STE 250
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2973
Country : US
Telephone Number : 909-749-5204
Fax Number : 909-217-3456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2018
Last Update Date : 09/29/2021

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Directions to “ AMBER LAQUITA PORTIS ” Practice Location

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