Individual
MARK RAINALDO PORVAZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1425 S GREENFIELD RD STE 101, MESA, AZ 85206-5505
(809) 645-8004
Mailing address
1425 S GREENFIELD RD STE 101, MESA, AZ 85206-5505
(809) 645-8004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
010690
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2019
Last updated
12/03/2024
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