Provider Demographics
NPI:1558315671
Name:PORTILLA, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PORTILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BG1 VIA DEL BOSQUE
Mailing Address - Street 2:BOSQUE DEL LAGO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6058
Mailing Address - Country:US
Mailing Address - Phone:787-548-2939
Mailing Address - Fax:787-760-5069
Practice Address - Street 1:RECINTO DE CIENCIAS MEDICAS
Practice Address - Street 2:DEPARTAMENTO DE ANESTESIOLOGIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-0640
Practice Address - Fax:787-758-1327
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8538207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology