Provider Demographics
NPI:1518478247
Name:PORTER, PAULITA SESE
Entity Type:Individual
Prefix:MRS
First Name:PAULITA
Middle Name:SESE
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAULITA SUSANA
Other - Middle Name:SESE
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3288 EL CAJON BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1430
Mailing Address - Country:US
Mailing Address - Phone:619-521-5720
Mailing Address - Fax:619-521-5728
Practice Address - Street 1:3288 EL CAJON BLVD STE 13
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1430
Practice Address - Country:US
Practice Address - Phone:619-521-5720
Practice Address - Fax:619-521-5728
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3704Medicaid