Provider Demographics
NPI:1982417036
Name:PORTA, DEBORAH (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PORTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 AMERICAS WAY # 13186
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-7600
Mailing Address - Country:US
Mailing Address - Phone:612-501-0242
Mailing Address - Fax:
Practice Address - Street 1:142 5TH ST APT 9
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6189
Practice Address - Country:US
Practice Address - Phone:612-501-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR054165163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight