MEDICARE: YVETTE PORTELL PHD

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
1	103TC0700X	Clinical Psychologist	1820	PR

General Provider Information

NPI Number	:	1528127883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE PORTELL PHD

Provider Business Mailing Address
First Line	:	PO BOX 10021
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00988-1021
Country	:	US
Telephone Number	:	939-940-8366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 AVE PONCE DE LEON
Second Line	:	SUITE GM-4 COBIAN'S PLAZA
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1820
Country	:	US
Telephone Number	:	939-940-8366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	10/20/2020

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