Provider Demographics
NPI:1144824285
Name:DONALD J PORTOCARRERO D O INC
Entity type:Organization
Organization Name:DONALD J PORTOCARRERO D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORTOCARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-461-5408
Mailing Address - Street 1:122A E FOOTHILL BLVD UNIT 304
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2505
Mailing Address - Country:US
Mailing Address - Phone:626-461-5408
Mailing Address - Fax:626-461-5436
Practice Address - Street 1:623 W DUARTE RD STE 8
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7349
Practice Address - Country:US
Practice Address - Phone:626-461-5408
Practice Address - Fax:626-461-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty