Provider Demographics
NPI:1518986850
Name:PORTUONDO, JOSE E (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:PORTUONDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 W LAGO DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6523
Mailing Address - Country:US
Mailing Address - Phone:305-662-9372
Mailing Address - Fax:
Practice Address - Street 1:5000 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2008
Practice Address - Country:US
Practice Address - Phone:305-669-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 26576207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
92548YMedicare ID - Type Unspecified
D27648Medicare UPIN