Provider Demographics
NPI:1417254715
Name:PORTOCARRERO, JOSE SALVADOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:SALVADOR
Last Name:PORTOCARRERO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9993 TOWN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5836
Mailing Address - Country:US
Mailing Address - Phone:646-430-3957
Mailing Address - Fax:
Practice Address - Street 1:9993 TOWN LAKE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5836
Practice Address - Country:US
Practice Address - Phone:646-430-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9847103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical