Provider Demographics
NPI:1932345360
Name:VERNICKA D. PORTER-SALES, DO, PA
Entity Type:Organization
Organization Name:VERNICKA D. PORTER-SALES, DO, PA
Other - Org Name:KIDZ 1ST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNICKA
Authorized Official - Middle Name:DASHAWN
Authorized Official - Last Name:PORTER-SALES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-899-5439
Mailing Address - Street 1:17634 BEAR RIVER LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1558
Mailing Address - Country:US
Mailing Address - Phone:409-782-2434
Mailing Address - Fax:218-812-2408
Practice Address - Street 1:11398 BANDERA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6840
Practice Address - Country:US
Practice Address - Phone:210-543-7334
Practice Address - Fax:210-543-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152342501Medicaid