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General NPI Number Information
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NPI Number | 1043405830
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Entity Type | Individual
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Provider Name | DENISE PORTUGAL M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 2021 22ND ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-3802
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Country | US
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Telephone | 661-864-7076
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Fax | 661-864-7131
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Provider Business Mailing Address
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Address Line | 2021 22ND ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-3802
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Country | US
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Telephone | 661-864-7076
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Fax | 661-864-7131
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | RESIDENT
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A108655
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License Number State | CA
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