Healthcare Provider Details

I. General information

NPI: 1023575222
Provider Name (Legal Business Name): SYLVIA HELENA ESTRADA PORRAS SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 STARLIT PL
EL PASO TX
79912-1246
US

IV. Provider business mailing address

808 STARLIT PL
EL PASO TX
79912-1246
US

V. Phone/Fax

Practice location:
  • Phone: 915-275-9552
  • Fax:
Mailing address:
  • Phone: 915-275-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number19-120
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: