Provider Demographics
NPI:1083135719
Name:PORRATA, GLENIVER
Entity Type:Individual
Prefix:
First Name:GLENIVER
Middle Name:
Last Name:PORRATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE GAUTIER BENITEZ
Mailing Address - Street 2:EDIF ANGORA 162
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-641-9133
Mailing Address - Fax:787-744-1118
Practice Address - Street 1:AVE GAUTIER BENITEZ
Practice Address - Street 2:EDIF ANGORA 162
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-641-9133
Practice Address - Fax:787-744-1118
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse