Provider Demographics
NPI:1669464517
Name:MULERO PORTELA, EUGENIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:
Last Name:MULERO PORTELA
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:PO BOX 10249
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0249
Mailing Address - Country:US
Mailing Address - Phone:787-843-5360
Mailing Address - Fax:787-812-0417
Practice Address - Street 1:917 AVE. TITO CASTRO
Practice Address - Street 2:SUITE 519 TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-6810
Practice Address - Country:US
Practice Address - Phone:787-843-5360
Practice Address - Fax:787-812-0417
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10847208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG37150Medicare UPIN
PR0088685Medicare UPIN