Provider Demographics
NPI:1053720623
Name:PORIO, ELIZABETH (RN, BSN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PORIO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:REINKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 S AMPHLETT BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2727
Mailing Address - Country:US
Mailing Address - Phone:925-412-3425
Mailing Address - Fax:
Practice Address - Street 1:1700 S AMPHLETT BLVD STE 221
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2727
Practice Address - Country:US
Practice Address - Phone:925-412-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034897163W00000X
MARN2274480163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant