Active NPI
Stephen Portuges, PHD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1326189929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY6634
- Practice address
- 3338 Cabrillo Blvd
Los Angeles, CA 90066-1502 - Phone
- (310) 397-7279
- Fax
- (310) 636-1997
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY6634 | CA | Primary |
Addresses
Primary practice location
3338 Cabrillo Blvd
Los Angeles, CA 90066-1502
Mailing address
3338 Cabrillo Blvd
Los Angeles, CA 90066-1502
Phone (310) 397-7279
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2022 through Nov 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY6634 | CA | MD | Clinical Psychologist |
| 6634 | CA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326189929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3338 CABRILLO BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900661502",
"telephone_number": "310-397-7279",
"fax_number": "310-636-1997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3338 CABRILLO BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900661502",
"telephone_number": "310-397-7279",
"fax_number": "310-636-1997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTUGES",
"first_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY6634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.