Healthcare Provider Details

I. General information

NPI: 1710158001
Provider Name (Legal Business Name): EUGENE G. PORRECA, MD., LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 BOX CANYON DR #110
LAS VEGAS NV
89128-1119
US

IV. Provider business mailing address

2655 BOX CANYON DR #110
LAS VEGAS NV
89128-1119
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4554
  • Fax: 702-796-9225
Mailing address:
  • Phone: 702-869-4554
  • Fax: 702-796-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5987
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5987
License Number StateNV

VIII. Authorized Official

Name: DR. EUGENE G PORRECA
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 702-869-4554