Provider Demographics
NPI:1922447317
Name:PORRAS BLANCO, ROMMY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ROMMY
Middle Name:MICHELLE
Last Name:PORRAS BLANCO
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 1:1190 OLIVEWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1256
Mailing Address - Country:US
Mailing Address - Phone:209-490-4620
Mailing Address - Fax:
Practice Address - Street 1:1190 OLIVEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1256
Practice Address - Country:US
Practice Address - Phone:209-490-4620
Practice Address - Fax:209-490-4621
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA152915208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty