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NPI Code Detail

MEDICARE: PORSCHE SKINNER BA PSYCHOLGY

MEDICARE: PORSCHE SKINNER BA PSYCHOLGY
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
1171M00000XCase Manager/Care CoordinatorCA

General Provider Information

NPI Number : 1538625066
Entity Type Code : Individual
Provider Name (Legal Business Name) : PORSCHE SKINNER BA PSYCHOLGY
Provider Business Mailing Address
First Line : 1107 W 62ND ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3733
Country : US
Telephone Number : 323-501-8212
Fax Number :
Provider Business Practice Location Address
First Line : 2644 30TH ST STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3051
Country : US
Telephone Number : 323-501-8212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2019
Last Update Date : 02/20/2019

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