Provider Information for 1164886842
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MATEUS PORTER LMFT
Sex: Male
NPI: 1164886842
Last Updated: 2021-05-27
Certification Date: 2021-05-27
Certification Date: 2021-05-27
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1164886842 | ||||||||||||
| Enumeration Date | 2016-04-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1700 S AMPHLETT BLVD STE 250E SAN MATEO, CA 94402-2728 United States Phone: 650-549-5683 | Fax: | ||||||||||||
| Primary Practice Address | 1486 HUNTINGTON AVE STE 100 SOUTH SAN FRANCISCO, CA 94080-5971 United States Phone: 650-877-8642 | Fax:628-239-0525 | ||||||||||||
| Secondary Practice Address(es) | 1700 S AMPHLETT BLVD STE 250E | ||||||||||||
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