MEDICARE: ISAIAS ALFREDO PORCAYO

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1386413953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAIAS ALFREDO PORCAYO

Provider Business Mailing Address
First Line	:	1855 TUSCANY DR
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-8334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 TUSCANY DR
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-8334
Country	:	US
Telephone Number	:	530-713-3664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	12/25/2023

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Directions to “ ISAIAS ALFREDO PORCAYO ” Practice Location

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