Provider Demographics
NPI:1700405248
Name:PORRAS DOS SANTOS, EDWARD ALEXANDER
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:PORRAS DOS SANTOS
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 1:21540 PROVINCIAL BLVD APT 2128
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7540
Mailing Address - Country:US
Mailing Address - Phone:832-706-5544
Mailing Address - Fax:
Practice Address - Street 1:21540 PROVINCIAL BLVD APT 2128
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7540
Practice Address - Country:US
Practice Address - Phone:832-706-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-207246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant