Organization Name: | CARLOS PORTER, MD, PA |
NPI Number: | 1548475320 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARLOS PORTER (MEDICAL DIRECTOR) |
Mailing Address: | 2318 Pat Booker Rd Universal City |
State: | TX US |
Postal Code: | 781483229 |
Phone Number: | 2106590323 |
Fax Number: | 2106597668 |
NPI Enumeration Date: | 05/14/2007 |
NPI Last Update Date: | 06/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | J6667 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |