Healthcare Provider Details

I. General information

NPI: 1932345360
Provider Name (Legal Business Name): VERNICKA D. PORTER-SALES, DO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11398 BANDERA RD SUITE 201
SAN ANTONIO TX
78250-6840
US

IV. Provider business mailing address

17634 BEAR RIVER LN
HUMBLE TX
77346-1558
US

V. Phone/Fax

Practice location:
  • Phone: 210-543-7334
  • Fax: 210-543-7338
Mailing address:
  • Phone: 409-782-2434
  • Fax: 218-812-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4650
License Number StateTX

VIII. Authorized Official

Name: DR. VERNICKA DASHAWN PORTER-SALES
Title or Position: OWNER/PEDIATRICIAN
Credential: DO
Phone: 409-899-5439