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NPI Code Detail

MEDICARE: SUSANA PORTALES

MEDICARE: SUSANA PORTALES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1053999268
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANA PORTALES
Provider Business Mailing Address
First Line : 6416 NW 5TH WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-6112
Country : US
Telephone Number : 888-754-0398
Fax Number : 954-982-6491
Provider Business Practice Location Address
First Line : 121 INTERPARK BLVD STE 104
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78216-1844
Country : US
Telephone Number : 888-754-0398
Fax Number : 954-982-6491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2021
Last Update Date : 06/09/2026

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Directions to “ SUSANA PORTALES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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