Healthcare Provider Details

I. General information

NPI: 1629509898
Provider Name (Legal Business Name): JORGE IGNACIO PORTUONDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST FL 4
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1 BAYLOR PLZ
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberV2222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: