Healthcare Provider Details

I. General information

NPI: 1952383838
Provider Name (Legal Business Name): VERNICKA DESHAWN PORTER-SALES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17634 BEAR RIVER LN
HUMBLE TX
77346-1558
US

IV. Provider business mailing address

11097B NORTHWEST FREEWAY
HOUSTON TX
77092
US

V. Phone/Fax

Practice location:
  • Phone: 409-782-2434
  • Fax:
Mailing address:
  • Phone: 713-496-1331
  • Fax: 713-496-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4650
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberL4650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: