Individual
DANA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCSS
Contact information
Practice address
4893 TURQUOISE DR NE, RIO RANCHO, NM 87124-4573
(505) 896-3333
Mailing address
4893 TURQUOISE DR NE, RIO RANCHO, NM 87124-4573
(505) 896-3333
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44842
—
NM
Enumeration date
08/01/2011
Last updated
08/01/2011
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