Healthcare Provider Details

I. General information

NPI: 1326239658
Provider Name (Legal Business Name): MEREDITH PORTALATIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH PORTALATIN PEREZ MD

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 129 KM. 8, SAN LUIS HOSPITAL PAVIA, SUITE 104
ARECIBO PR
00613
US

IV. Provider business mailing address

PO BOX 235
BAJADERO PR
00616-0235
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-7272
  • Fax: 787-650-7248
Mailing address:
  • Phone: 787-509-2458
  • Fax: 787-650-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.202377
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME 117372
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number18685
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01072856A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: