Provider Demographics
NPI:1538120340
Name:PORTELA, RAMON M (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:M
Last Name:PORTELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMON
Other - Middle Name:M
Other - Last Name:PORTELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10431
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0431
Mailing Address - Country:US
Mailing Address - Phone:787-781-2565
Mailing Address - Fax:787-782-9524
Practice Address - Street 1:AVE JESUS T PINERO 1250 CAPARRA TERRACE
Practice Address - Street 2:CENTRO OFTALMOLOGICO METROPOLITANO CSP
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-2565
Practice Address - Fax:787-782-9524
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3274207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE08201Medicare UPIN
PR0024161CMedicare PIN