Provider Demographics
NPI:1174388060
Name:PORTORREAL FERMIN, BETANIA
Entity type:Individual
Prefix:
First Name:BETANIA
Middle Name:
Last Name:PORTORREAL FERMIN
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 1:103 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5713
Mailing Address - Country:US
Mailing Address - Phone:321-697-2334
Mailing Address - Fax:407-201-3608
Practice Address - Street 1:103 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5713
Practice Address - Country:US
Practice Address - Phone:321-697-2334
Practice Address - Fax:407-201-3608
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide