Healthcare Provider Details

I. General information

NPI: 1366644486
Provider Name (Legal Business Name): SHAROUN SEAN PORAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR SUITE 115
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR SUITE 115
FOOTHILL RANCH CA
92610-2844
US

V. Phone/Fax

Practice location:
  • Phone: 949-393-3193
  • Fax: 949-393-3199
Mailing address:
  • Phone: 949-393-3193
  • Fax: 949-393-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA97592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: