Provider Demographics
NPI:1366685448
Name:PORTALATIN PEREZ, MONICA L (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:PORTALATIN PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SAN JOSE 309
Mailing Address - Street 2:CALLE FRANCISCO PALAU
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1908
Mailing Address - Country:US
Mailing Address - Phone:787-842-5288
Mailing Address - Fax:
Practice Address - Street 1:POLICLINICA FAMILIAR DEL SUR
Practice Address - Street 2:PONCE MALL- SUITE 15 CARR 2 KM 225.8
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-840-8500
Practice Address - Fax:787-840-8500
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17345208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17,345OtherSTATE LICENCE