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General NPI Number Information
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NPI Number | 1053190082
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Entity Type | Individual
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Provider Name | BEATRIZ ILEANA PORTUONDO SAO PS47405
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Gender | Female
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 13780 SW 26TH ST STE 108
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City | MIAMI
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State | FL
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Zip | 33175-6302
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Country | US
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Telephone | 305-424-7212
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Fax | 305-424-7324
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Provider Business Mailing Address
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Address Line | 8221 SW 186TH ST
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City | CUTLER BAY
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State | FL
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Zip | 33157-7353
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Country | US
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Telephone | 786-587-3341
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Fax | 305-424-7324
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS47405
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License Number State | FL
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