Provider Demographics
NPI:1497431431
Name:PORTER, KEMARA FARCHASIA
Entity Type:Individual
Prefix:
First Name:KEMARA
Middle Name:FARCHASIA
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26080 BASE LINE ST APT 186
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-7012
Mailing Address - Country:US
Mailing Address - Phone:760-867-8555
Mailing Address - Fax:
Practice Address - Street 1:26080 BASE LINE ST APT 186
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-7012
Practice Address - Country:US
Practice Address - Phone:760-867-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty