Healthcare Provider Details

I. General information

NPI: 1801035886
Provider Name (Legal Business Name): ARTURO PORTALES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14642 NEWPORT AVE SUITE 270
TUSTIN CA
92780-6057
US

IV. Provider business mailing address

PO BOX 50157
IRVINE CA
92619-0157
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-6642
  • Fax: 714-442-6652
Mailing address:
  • Phone: 714-600-5876
  • Fax: 714-442-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA11246
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA11246
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA11246
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA11246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: