| Organization Name: | PORTNER MEDICAL CORP |
| NPI Number: | 1235162850 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARVIN M PORTNER (PRESIDENT) |
| Mailing Address: | 865 Napoli Dr Pacific Palisades |
| State: | CA US |
| Postal Code: | 902724515 |
| Phone Number: | 3104546226 |
| Fax Number: | 3104545318 |
| NPI Enumeration Date: | 07/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | C28757 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |