Provider Demographics
NPI:1144617986
Name:PORTALATIN, EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:PORTALATIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4808
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4808
Mailing Address - Country:US
Mailing Address - Phone:787-245-3468
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 119.2
Practice Address - Street 2:BO CAIMITAL ALTO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-710-5835
Practice Address - Fax:787-997-1616
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21720207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery