Provider Demographics
NPI:1205551991
Name:PORIZEK, VINISSA
Entity type:Individual
Prefix:
First Name:VINISSA
Middle Name:
Last Name:PORIZEK
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 1:21207 AVALON BLVD SPC 178
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6752
Mailing Address - Country:US
Mailing Address - Phone:562-987-5722
Mailing Address - Fax:562-987-4586
Practice Address - Street 1:3125 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4932
Practice Address - Country:US
Practice Address - Phone:562-987-5722
Practice Address - Fax:562-987-4586
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA191989Medicaid