MEDICARE: VERONICA DELATORRE PORTERFIELD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	NU100000138	DC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	363A00000X	Physician Assistant	0110007053	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0110007053	OTHER	VA	VIRGINIA LICENSE

General Provider Information

NPI Number	:	1255624037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA DELATORRE PORTERFIELD PA-C

Provider Business Mailing Address
First Line	:	1 PARK WEST CIR STE 301
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-4518
Country	:	US
Telephone Number	:	804-893-3920
Fax Number	:	804-858-0101

Provider Business Practice Location Address
First Line	:	7051 HEATHCOTE VILLAGE WAY STE 155
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3268
Country	:	US
Telephone Number	:	571-248-0167
Fax Number	:	571-248-0173

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	08/20/2025

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