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General NPI Number Information
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NPI Number | 1831357474
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Entity Type | Individual
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Provider Name | MANUEL DE LA PORTILLA MH6485
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Gender | Male
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 15660 SW 72ND ST
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City | MIAMI
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State | FL
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Zip | 33193-1923
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Country | US
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Telephone | 786-697-1150
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Fax | 786-541-1526
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Provider Business Mailing Address
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Address Line | 3477 VIVIAN RD
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City | NORTH PORT
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State | FL
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Zip | 34288-7886
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Country | US
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Telephone | 305-389-2374
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6485
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License Number State | FL
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