MEDICARE: RICARDO PORRAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC21097	CA

General Provider Information

NPI Number	:	1750579546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO PORRAS

Provider Business Mailing Address
First Line	:	1123 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2212
Country	:	US
Telephone Number	:	818-242-8804
Fax Number	:	818-242-4442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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Directions to “ RICARDO PORRAS ” Practice Location

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