Healthcare Provider Details

I. General information

NPI: 1720050230
Provider Name (Legal Business Name): MARCO ANTONIO ALBARRAN PORTILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 CALLE DR MANUEL Z GANDIA
PONCE PR
00717-0235
US

IV. Provider business mailing address

PO BOX 7293
PONCE PR
00732-7293
US

V. Phone/Fax

Practice location:
  • Phone: 787-309-5003
  • Fax:
Mailing address:
  • Phone: 787-309-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5967
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: