Provider Demographics
NPI:1396378956
Name:THE PATIENT PORTAL GROUP LLC
Entity Type:Organization
Organization Name:THE PATIENT PORTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-505-1464
Mailing Address - Street 1:4532 US HIGHWAY 19 STE 7
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4950
Mailing Address - Country:US
Mailing Address - Phone:727-281-4075
Mailing Address - Fax:
Practice Address - Street 1:4532 US HIGHWAY 19 STE 7
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4950
Practice Address - Country:US
Practice Address - Phone:727-281-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health