Provider Demographics
NPI:1538357710
Name:PORTUONDO, HECTOR ALEJANDRO (BS, BA, RDCS, RVT)
Entity type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:ALEJANDRO
Last Name:PORTUONDO
Suffix:
Gender:M
Credentials:BS, BA, RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2908
Mailing Address - Country:US
Mailing Address - Phone:561-758-2265
Mailing Address - Fax:561-828-7633
Practice Address - Street 1:101 WEDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2908
Practice Address - Country:US
Practice Address - Phone:561-758-2265
Practice Address - Fax:561-828-7633
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31334246XS1301X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0344Medicare UPIN