Provider Demographics
NPI:1639751308
Name:PORRAGAS-PASEIRO, HECTOR SANTIAGO
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:SANTIAGO
Last Name:PORRAGAS-PASEIRO
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 1:12631 E 17TH AVE STE B198-6
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2529
Mailing Address - Country:US
Mailing Address - Phone:303-724-2052
Mailing Address - Fax:
Practice Address - Street 1:12631 E 17TH AVE STE B198-6
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2529
Practice Address - Country:US
Practice Address - Phone:303-724-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0008842390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program