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General NPI Number Information
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NPI Number | 1023091717
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Entity Type | Individual
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Provider Name | CARMEN G PORTOGUES PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1901 S.W. 172 AVE. MEMORIAL HOSPITAL MIRAMAR
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City | MIRAMAR
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State | FL
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Zip | 33029
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Country | US
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Telephone | 954-538-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 8814 N.W. 180 TERRACE
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City | HIALEAH
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State | FL
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Zip | 33018
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Country | US
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Telephone | 305-819-8197
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2405
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 2405
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License Number State | FL
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