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NPI Code Detail

MEDICARE: BRANDON KYLE PORTER PA

MEDICARE: BRANDON KYLE PORTER PA
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
1363A00000XPhysician AssistantCA

General Provider Information

NPI Number : 1720516438
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON KYLE PORTER PA
Provider Business Mailing Address
First Line : 21885 BIRCHWOOD
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92692-4223
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8700 GRACIE ALLEN DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-3811
Country : US
Telephone Number : 310-423-3277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2017
Last Update Date : 05/24/2017

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Directions to “ BRANDON KYLE PORTER PA” Practice Location

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