Provider Demographics
NPI:1437586674
Name:PORTER, LA'VAR MAR'QIES
Entity Type:Individual
Prefix:
First Name:LA'VAR
Middle Name:MAR'QIES
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 N TENAYA WAY # 33901
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9995
Mailing Address - Country:US
Mailing Address - Phone:702-337-6432
Mailing Address - Fax:
Practice Address - Street 1:1956 DWARF STAR DR APT 2034
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-6244
Practice Address - Country:US
Practice Address - Phone:702-337-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner