| Organization Name: | PORTO INC |
| NPI Number: | 1164870150 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARRELL RENEE MARBLE (CEO) |
| Mailing Address: | 12 S San Gorgonio Ave Banning |
| State: | CA US |
| Postal Code: | 922206002 |
| Phone Number: | 9518493207 |
| Fax Number: | 8775509333 |
| NPI Enumeration Date: | 05/31/2016 |
| NPI Last Update Date: | 05/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 334700050 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |