Provider Demographics
NPI:1396032934
Name:PORTO, MARIANO JR (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANO
Middle Name:
Last Name:PORTO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9746 N 90TH PL STE 203
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5085
Mailing Address - Country:US
Mailing Address - Phone:480-614-0707
Mailing Address - Fax:480-614-0353
Practice Address - Street 1:9746 N 90TH PL STE 203
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5085
Practice Address - Country:US
Practice Address - Phone:480-614-0707
Practice Address - Fax:480-614-0353
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-530362084N0400X
PAMD4852542084N0400X
TXQ46682084N0600X
AZ590642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty