Provider Demographics
NPI:1952383838
Name:PORTER-SALES, VERNICKA DESHAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:VERNICKA
Middle Name:DESHAWN
Last Name:PORTER-SALES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11097B NORTHWEST FREEWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092
Mailing Address - Country:US
Mailing Address - Phone:713-496-1331
Mailing Address - Fax:713-496-1334
Practice Address - Street 1:17634 BEAR RIVER LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1558
Practice Address - Country:US
Practice Address - Phone:409-782-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4650208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152342501Medicaid