Provider Demographics
NPI:1700613817
Name:PORTELA, JAVIER ANTONIO
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:ANTONIO
Last Name:PORTELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:ANTONIO
Other - Last Name:PORTELA MARQUES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:N17 CALLE GAVILANES, TIERRA ALTA 2
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3200
Mailing Address - Country:US
Mailing Address - Phone:787-234-9090
Mailing Address - Fax:
Practice Address - Street 1:N17 CALLE GAVILANES, TIERRA ALTA 2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3200
Practice Address - Country:US
Practice Address - Phone:787-234-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty