Provider Demographics
NPI:1598813461
Name:PORCH, JULIET V (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:V
Last Name:PORCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0740
Mailing Address - Country:US
Mailing Address - Phone:787-204-9040
Mailing Address - Fax:
Practice Address - Street 1:#16 CALLE JUAN MARI RAMOS
Practice Address - Street 2:VISTA LAS MESAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-204-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR198012086S0122X
CAA737572086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery