Healthcare Provider Details

I. General information

NPI: 1013495084
Provider Name (Legal Business Name): NATHAN PORTUGUES RRT-SDS, RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE. MOB #7
FONTANA CA
92335
US

IV. Provider business mailing address

37136 AMATEUR WAY
BEAUMONT CA
92223-8099
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-4432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: