Provider Demographics
NPI:1821553389
Name:PORTELA E.N.T., PA
Entity Type:Organization
Organization Name:PORTELA E.N.T., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-669-7144
Mailing Address - Street 1:3100 SW 62ND AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-669-7144
Mailing Address - Fax:305-663-8545
Practice Address - Street 1:3100 SW 62ND AVE STE 124
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-669-7144
Practice Address - Fax:305-663-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008496300Medicaid