Provider Demographics
NPI:1235159005
Name:PORTELA, ROSALIZ M (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIZ
Middle Name:M
Last Name:PORTELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10431
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0431
Mailing Address - Country:US
Mailing Address - Phone:787-781-2565
Mailing Address - Fax:
Practice Address - Street 1:AVE JESUS T PINERO
Practice Address - Street 2:#1250
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4109
Practice Address - Country:US
Practice Address - Phone:787-781-2565
Practice Address - Fax:787-782-9524
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044112207W00000X
PR17093207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology