Provider Demographics
NPI:1043405830
Name:PORTUGAL, DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:PORTUGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3802
Mailing Address - Country:US
Mailing Address - Phone:661-864-7076
Mailing Address - Fax:661-864-7131
Practice Address - Street 1:2021 22ND ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3802
Practice Address - Country:US
Practice Address - Phone:661-864-7076
Practice Address - Fax:661-864-7131
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARESIDENT208600000X
CAA108655208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery