MEDICARE: DR. JAVIER ANTONIO PORTELA MD

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	363AM0700X	Medical Physician Assistant	2766	PR

General Provider Information

NPI Number	:	1700613817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVIER ANTONIO PORTELA MD

Provider Business Mailing Address
First Line	:	N17 CALLE GAVILANES, TIERRA ALTA 2
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3200
Country	:	US
Telephone Number	:	787-234-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	N17 CALLE GAVILANES, TIERRA ALTA 2
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3200
Country	:	US
Telephone Number	:	787-234-9090
Fax Number	:

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

Provider Enumeration Date	:	09/14/2024
Last Update Date	:	08/19/2025

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