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NPI Code Detail

MEDICARE: MS. CANDICE ROSIE PORRAS A.A.

MEDICARE: MS. CANDICE ROSIE PORRAS A.A.
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 Coordinator
2101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ICAN877OTHERCALA COUNTY DMH

General Provider Information

NPI Number : 1972834745
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CANDICE ROSIE PORRAS A.A.
Provider Business Mailing Address
First Line : 18612 SANTA ANA AVE
Second Line :
City : BLOOMINGTON
State : CA
Zip : 92316-2639
Country : US
Telephone Number : 909-421-7120
Fax Number :
Provider Business Practice Location Address
First Line : 18612 SANTA ANA AVE
Second Line :
City : BLOOMINGTON
State : CA
Zip : 92316-2639
Country : US
Telephone Number : 909-421-7120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2010
Last Update Date : 04/05/2024

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