Provider Demographics
NPI:1568154094
Name:DE LA PORTILLA MONTERO, ANA BERTA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:BERTA
Last Name:DE LA PORTILLA MONTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SW 67TH LN
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4811
Mailing Address - Country:US
Mailing Address - Phone:786-372-3819
Mailing Address - Fax:
Practice Address - Street 1:14040 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6809
Practice Address - Country:US
Practice Address - Phone:754-707-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant