Healthcare Provider Details

I. General information

NPI: 1356992358
Provider Name (Legal Business Name): JENNIFER DENISE PORS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 910 W 10TH AVENUE JENNEFER PORS, DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE VANCOUV
VANCOUVER BC
V5Z 4E3
CA

IV. Provider business mailing address

300 PASTEUR DR RM L235, DEPARTMENT OF PATHOLOGY SANTA CLARA COUNTY
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 604-875-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: