Healthcare Provider Details

I. General information

NPI: 1871306316
Provider Name (Legal Business Name): RICARDO PORRAS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 E SERENE AVE
HENDERSON NV
89074-6507
US

IV. Provider business mailing address

2961 E SERENE AVE
HENDERSON NV
89074-6507
US

V. Phone/Fax

Practice location:
  • Phone: 702-948-4848
  • Fax: 702-948-4845
Mailing address:
  • Phone: 702-948-4848
  • Fax: 702-948-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: