Provider Demographics
NPI:1407685738
Name:PORRAS, KEVINN F
Entity type:Individual
Prefix:
First Name:KEVINN
Middle Name:F
Last Name:PORRAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 TYLER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4181
Mailing Address - Country:US
Mailing Address - Phone:833-607-0895
Mailing Address - Fax:
Practice Address - Street 1:3590 TYLER ST STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4181
Practice Address - Country:US
Practice Address - Phone:833-607-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker