Healthcare Provider Details

I. General information

NPI: 1821553389
Provider Name (Legal Business Name): PORTELA E.N.T., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE STE 124
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE STE 124
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-7144
  • Fax: 305-663-8545
Mailing address:
  • Phone: 305-669-7144
  • Fax: 305-663-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL ANTONIO PORTELA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-669-7144