Provider Demographics
NPI:1801866298
Name:PORRATA, JANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANNETTE
Middle Name:
Last Name:PORRATA
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 12121
Mailing Address - Street 2:LOIZA ST STA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-0121
Mailing Address - Country:US
Mailing Address - Phone:787-250-6601
Mailing Address - Fax:787-765-2088
Practice Address - Street 1:URB LA MERCED
Practice Address - Street 2:CABO H ALVELO 566
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918-0000
Practice Address - Country:US
Practice Address - Phone:787-250-6601
Practice Address - Fax:787-765-2088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9659208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41343Medicare UPIN
PR84568Medicare ID - Type Unspecified