Provider Demographics
NPI:1972599397
Name:PORTELA, RAFAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:R
Last Name:PORTELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:SUITE 124
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
Practice Address - Street 2:SUITE 124
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME53078207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059222600Medicaid
FL059222600Medicaid