Provider Demographics
NPI:1356191357
Name:PORTER, SEAN CLAYTON
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:CLAYTON
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 LINCOLN CT APT 114
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-5350
Mailing Address - Country:US
Mailing Address - Phone:309-502-1678
Mailing Address - Fax:
Practice Address - Street 1:1627 LINCOLN CT APT 114
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-5350
Practice Address - Country:US
Practice Address - Phone:309-502-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator