Provider Demographics
NPI:1861891376
Name:PORCIC, ADEMIRA (LVN)
Entity type:Individual
Prefix:
First Name:ADEMIRA
Middle Name:
Last Name:PORCIC
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ADEMIRA
Other - Middle Name:
Other - Last Name:PORCIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:4205 ARCH DR APT 20
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3260
Mailing Address - Country:US
Mailing Address - Phone:701-306-5823
Mailing Address - Fax:
Practice Address - Street 1:4434 HARDING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:701-306-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2019-05-20
Deactivation Date:2018-11-21
Deactivation Code:
Reactivation Date:2019-01-30
Provider Licenses
StateLicense IDTaxonomies
CA696055164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse