Healthcare Provider Details

I. General information

NPI: 1386390649
Provider Name (Legal Business Name): MARIA ALEJANDRA PORTELA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 771 KM 5.6 BO. BARRANCAS
BARRANQUITAS PR
00794
US

IV. Provider business mailing address

HC 1 BOX 5152
BARRANQUITAS PR
00794-9727
US

V. Phone/Fax

Practice location:
  • Phone: 787-201-4435
  • Fax:
Mailing address:
  • Phone: 787-201-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25045
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: