Healthcare Provider Details

I. General information

NPI: 1114920758
Provider Name (Legal Business Name): HUMBERTO L PORRATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 S STATE ROAD 7 STE 102
WELLINGTON FL
33449-8099
US

IV. Provider business mailing address

3319 S STATE ROAD 7 STE 102
WELLINGTON FL
33449-8099
US

V. Phone/Fax

Practice location:
  • Phone: 561-270-5432
  • Fax: 561-560-8988
Mailing address:
  • Phone: 561-270-5432
  • Fax: 561-560-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME83317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: