Provider Demographics
NPI:1801035886
Name:PORTALES, ARTURO (DO)
Entity Type:Individual
Prefix:DR
First Name:ARTURO
Middle Name:
Last Name:PORTALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14642 NEWPORT AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6057
Mailing Address - Country:US
Mailing Address - Phone:714-442-6642
Mailing Address - Fax:714-442-6652
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-442-6642
Practice Address - Fax:714-442-6652
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA11246208D00000X, 207QA0401X, 208VP0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine