Healthcare Provider Details

I. General information

NPI: 1285845545
Provider Name (Legal Business Name): SILVIA PORTILLO RN.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CALLE CERRA
SAN JUAN PR
00907-5104
US

IV. Provider business mailing address

1800 CALLE ALCALA
SAN JUAN PR
00921-4344
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-1360
  • Fax: 787-723-6247
Mailing address:
  • Phone: 787-723-1360
  • Fax: 787-723-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number29552
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: