Provider Demographics
NPI:1346964772
Name:PORTUONDO, KAREN
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:
Last Name:PORTUONDO
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 1:13431 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6910
Mailing Address - Country:US
Mailing Address - Phone:786-973-3080
Mailing Address - Fax:
Practice Address - Street 1:13431 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6910
Practice Address - Country:US
Practice Address - Phone:786-973-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117365106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician