Provider Demographics
NPI:1700204005
Name:PORTILLA-CINTRON, ANTONIO MANUEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MANUEL
Last Name:PORTILLA-CINTRON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:1630 MASON AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4503
Practice Address - Country:US
Practice Address - Phone:386-238-9064
Practice Address - Fax:386-238-9063
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR186711744R1102X
FLME132083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No1744R1102XOther Service ProvidersSpecialistResearch Study