Provider Demographics
NPI:1396300448
Name:PORRAS PERLA, CARLOTA ELEONORA (DDS)
Entity type:Individual
Prefix:
First Name:CARLOTA
Middle Name:ELEONORA
Last Name:PORRAS PERLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1756
Mailing Address - Country:US
Mailing Address - Phone:818-647-2775
Mailing Address - Fax:
Practice Address - Street 1:121 W SIERRA ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1756
Practice Address - Country:US
Practice Address - Phone:818-647-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist