Healthcare Provider Details

I. General information

NPI: 1871562652
Provider Name (Legal Business Name): EUGENE G PORRECA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 SMOKE RANCH RD SUITE 120
LAS VEGAS NV
89128
US

IV. Provider business mailing address

9030 W SAHARA AVE #550
LAS VEGAS NV
89117-5744
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4554
  • Fax: 702-796-9225
Mailing address:
  • Phone: 702-869-4554
  • Fax: 702-228-5653

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:
Title or Position:
Credential:
Phone: