Provider Demographics
NPI:1093460495
Name:PORTALES, CHRISTINA MELISSA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MELISSA
Last Name:PORTALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N SARAH DEEL DR APT 1026
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2659
Mailing Address - Country:US
Mailing Address - Phone:956-404-4699
Mailing Address - Fax:
Practice Address - Street 1:701 W PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5405
Practice Address - Country:US
Practice Address - Phone:281-996-9971
Practice Address - Fax:281-996-9980
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician