| Porta Verum | |
|
2630 1st Ave Suite 205 San Diego CA 92103-6599 | |
| (619) 866-4620 | |
| (619) 324-1023 |
| Full Name | Porta Verum |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2630 1st Ave, San Diego, California |
| Authorized Official Name and Position | Paula Kettula (OWNER) |
| Authorized Official Contact | 6198664620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Porta Verum 2630 1st Ave Suite 205 San Diego CA 92103-6599 Ph: (619) 866-4620 | Porta Verum 2630 1st Ave Suite 205 San Diego CA 92103-6599 Ph: (619) 866-4620 |
| NPI Number | 1740534239 |
|---|---|
| Provider Enumeration Date | 11/05/2012 |
| Last Update Date | 11/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740534239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 25403 (California) | Primary |
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