MEDICARE: MS. SABRINA 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	103TR0400X	Rehabilitation Psychologist	103KOOOOOX	NV

General Provider Information

NPI Number	:	1750636577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SABRINA PORRAS

Provider Business Mailing Address
First Line	:	555 E SILVERADO RANCH BLVD
Second Line	:	UNIT 2082
City	:	LAS VEGAS
State	:	NV
Zip	:	89183
Country	:	US
Telephone Number	:	702-572-8174
Fax Number	:	186-687-5398

Provider Business Practice Location Address
First Line	:	555 E SILVERADO RANCH BLVD
Second Line	:	UNIT 2082
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-6286
Country	:	US
Telephone Number	:	702-572-8174
Fax Number	:	186-687-5398

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

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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