Provider Demographics
NPI:1861639775
Name:PORCH, MONICA NICOLE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:NICOLE
Last Name:PORCH
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 1:1105 BROADWAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2767
Mailing Address - Country:US
Mailing Address - Phone:619-426-4872
Mailing Address - Fax:
Practice Address - Street 1:1105 BROADWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2767
Practice Address - Country:US
Practice Address - Phone:619-426-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator