Provider Demographics
NPI:1194747089
Name:SARAH J PORKKA MD MEDICAL CORPORATION
Entity type:Organization
Organization Name:SARAH J PORKKA MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORKKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-224-4250
Mailing Address - Street 1:3330 STERLING CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4262
Mailing Address - Country:US
Mailing Address - Phone:707-224-4250
Mailing Address - Fax:707-224-4435
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 211
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-224-4250
Practice Address - Fax:707-224-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68057207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01891ZMedicare ID - Type Unspecified