Provider Demographics
NPI:1639770902
Name:PORRAS SALGADO, JHON WILLIAM SR
Entity Type:Individual
Prefix:MR
First Name:JHON
Middle Name:WILLIAM
Last Name:PORRAS SALGADO
Suffix:SR
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 1:2957 SE ORCHID ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7831
Mailing Address - Country:US
Mailing Address - Phone:561-452-5663
Mailing Address - Fax:
Practice Address - Street 1:2957 SE ORCHID ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7831
Practice Address - Country:US
Practice Address - Phone:561-452-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-141921106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician