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General NPI Number Information
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NPI Number | 1164400818
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Entity Type | Individual
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Provider Name | ANTONIO MANUEL PORTILLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | CALLE GARCIA DE LA NOCEDA B-25
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City | VILLAS DE RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-887-3342
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Fax |
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Provider Business Mailing Address
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Address Line | JARDINES DE CUENCA BLDG APT 2C
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City | HATO REY
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-402-9651
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 6735
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License Number State | PR
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