Provider Demographics
NPI:1457391740
Name:PORZIO, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PORZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 PORT SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5326
Mailing Address - Country:US
Mailing Address - Phone:949-554-4733
Mailing Address - Fax:949-706-5629
Practice Address - Street 1:1730 PORT SHEFFIELD PL
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5326
Practice Address - Country:US
Practice Address - Phone:949-554-4733
Practice Address - Fax:949-706-5629
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76138174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA76138FMedicare ID - Type Unspecified
CAG24711Medicare UPIN