Provider Demographics
NPI:1093415796
Name:SMALLBONE, PORTIA INDIA (MBBS)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:INDIA
Last Name:SMALLBONE
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 AGETT ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:WESTERN AUSTRALIA
Mailing Address - Zip Code:06010
Mailing Address - Country:AU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:877-632-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program