Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | ME143122 | FL |
Y | 208000000X | Pediatrician | 4301113019 | MI |
NPI | 1063828267 |
---|---|
Provider Name | Adriana Marcela Porto |
First Address | Troy, MI 48084-1744 |
Second Address | Miami, FL 33176-2118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 20/05/2020 |