MACK PORTER JR. (NPI# 1912568841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912568841 |
| Entity Type | Individual |
| Full Name | MACK PORTER JR. |
| Credential | RN |
| Practice Address |
10802 College Pl Cerritos CA 90703-1579 |
| Practice Telephone | 5629249581 |
| Mailing Telephone | 5629249581 |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-06-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
437831 | CA | Nursing Service Providers |
| Street Address |
10802 COLLEGE PL |
| City | CERRITOS |
| State | CA |
| Zip Code | 90703-1579 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225016595 | College Hospital, Inc. | Psychiatric Hospital | 10802 College Pl, Cerritos, CA 90703-1505 | 2006-01-05 |
| 1245859420 | David Mercier | Social Worker | 10802 College Pl, Cerritos, CA 90703-1505 | 2020-04-08 |
| 1558995860 | Lam Duy Nguyen | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1505 | 2020-02-25 |
| 1649817578 | Diane Elizabeth Friedman | Social Worker | 10802 College Pl, Cerritos, CA 90703-1505 | 2019-12-10 |
| 1407491459 | Glaiza Landayan | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1505 | 2019-11-14 |
| 1285279232 | Daniel Steven Visda | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1505 | 2019-11-14 |
| 1376188680 | Kent Campbell | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1505 | 2019-11-11 |
| 1285279596 | Elaine Sebastian | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1579 | 2019-11-11 |
| 1831734144 | Edwin Rellosa Rellosa | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1505 | 2019-11-11 |
| 1417598921 | Shayna Renae Le Flore | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1505 | 2019-10-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909582 | Michael Wong Dental Corporation | Dentist | 11549 South Street, Cerritos, CA 90703 | 2020-10-15 |
| 1144837139 | Essential California Ipa Inc. | Health Maintenance Organization | 1800 Studebaker Rd., 100, Cerritos, CA 90703 | 2020-09-24 |
| 1447868377 | Auxilium Health Network, Inc. | Health Maintenance Organization | 18000 Studebaker Dr, Cerritos, CA 90703 | 2020-07-16 |
| 1154939098 | Absolute Medical Partners, A Professional Medical Corporation | Health Maintenance Organization | 18000 Studebaker Rd., Ste 100, Cerritos, CA 90703 | 2020-07-16 |
| 1558906487 | Vitruvian Care, Inc. | Health Maintenance Organization | 18000 Studebaker Road Suite 100, Cerritos, CA 90703 | 2019-11-14 |
| 1841843554 | Ha Tran Tsai Dental Corporation | Dentist | 16466 Norwalk Boulevard, Cerritos, CA 90703 | 2019-07-22 |
| 1457828097 | Angela Ofoegbu | Registered Nurse | 10733 Elgers St, Cerritos, CA 90703 | 2018-11-01 |
| 1689183352 | Zeela G Diwa | Occupational Therapist | 12736 Palm Street, Cerritos, CA 90703 | 2017-09-26 |
| 1114446119 | Cooper Lee | Physical Therapist | 18503 Noran Ave, Cerritos, CA 90703 | 2017-09-12 |
| 1295259141 | Miyeon Vivienne Lee | Nurse Practitioner | 13337 South Street #158, Cerritos, CA 90703 | 2017-08-02 |
| Find all providers in zip 90703 | ||||
| Taxonomy Code | 163WP0809X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health, Adult |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700437480 | Paul Hsia | Registered Nurse | 10802 College Pl, Cerritos, CA 90703-1579 | 2019-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033739677 | Tiffany Venice Turner | Registered Nurse | 2085 Rustin Ave Bldg 5, Riverside, CA 92507-2498 | 2020-04-23 |
| 1073144549 | Cedelia Untalan Cardenas | Registered Nurse | 17053 Foothill Blvd Bldg N, Fontana, CA 92335-3574 | 2020-02-03 |
| 1689204265 | Juvelyn Isip Ingal | Registered Nurse | 3853 Rosecrans St # Ca92110, San Diego, CA 92110-3115 | 2020-01-22 |
| 1043859531 | Klair Grace | Registered Nurse | 6460 Convoy Ct Spc 115, San Diego, CA 92117-2314 | 2019-12-31 |
| 1316588395 | Batoul Salameh | Registered Nurse | 19204 Bension Dr, Santa Clarita, CA 91350-3797 | 2019-10-01 |
| 1851949580 | Michael Perez | Registered Nurse | 25727 Mcbean Pkwy, Valencia, CA 91355-3704 | 2019-08-27 |
| 1982259792 | Beverly Austin Mccabe | Registered Nurse | 1720 E. Cesar Chavez Ave., Los Angeles, CA 90033 | 2019-08-08 |
| 1396390530 | Trisha Lynne Basman | Registered Nurse | 939 Snow Dr, Martinez, CA 94553-4715 | 2019-08-05 |
| 1003378043 | Ildefonso Silva Rodriguez | Registered Nurse | 2437 Woodcreek Rd, Camarillo, CA 93012-2537 | 2019-04-01 |
| 1518430842 | Jesus Lim | Registered Nurse | 695 Sea Vale St Unit 202, Chula Vista, CA 91910-1242 | 2019-01-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.