Provider Demographics
NPI:1124157474
Name:PORTEN, SIMA PRABODH (MD)
Entity type:Individual
Prefix:DR
First Name:SIMA
Middle Name:PRABODH
Last Name:PORTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158
Mailing Address - Country:US
Mailing Address - Phone:415-353-7171
Mailing Address - Fax:
Practice Address - Street 1:1825 4TH STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158
Practice Address - Country:US
Practice Address - Phone:415-353-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAXXXXXXXX208800000X
TXP4694208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319115701Medicaid
TX319115701Medicaid