Provider Demographics
NPI:1063461788
Name:PORTELA-ARRAIZA, JUAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:PORTELA-ARRAIZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:426 PASEO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-854-1686
Mailing Address - Fax:787-854-1981
Practice Address - Street 1:TORRE MEDICA DR. PEDRO BLANCO LUGO
Practice Address - Street 2:SUITE 352
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1686
Practice Address - Fax:787-854-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12710207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH74576Medicare UPIN