Provider Demographics
NPI:1962500157
Name:PORTER, LA DONNA ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LA DONNA
Middle Name:ROCHELLE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LA DONNA
Other - Middle Name:ROCHELLE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9693
Mailing Address - Country:US
Mailing Address - Phone:209-468-6768
Mailing Address - Fax:209-468-6747
Practice Address - Street 1:500 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:209-468-6768
Practice Address - Fax:209-468-6747
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071910Medicaid
CAG96304Medicare UPIN
CAZZZ13144ZMedicare ID - Type Unspecified