Provider Demographics
NPI:1750636577
Name:PORRAS, SABRINA
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:
Last Name:PORRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E SILVERADO RANCH BLVD
Mailing Address - Street 2:UNIT 2082
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183
Mailing Address - Country:US
Mailing Address - Phone:702-572-8174
Mailing Address - Fax:186-687-5398
Practice Address - Street 1:555 E SILVERADO RANCH BLVD
Practice Address - Street 2:UNIT 2082
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6286
Practice Address - Country:US
Practice Address - Phone:702-572-8174
Practice Address - Fax:186-687-5398
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103KOOOOOX103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation