Provider Demographics
NPI:1952101867
Name:PORTILLA, ARIEL RAMON
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:RAMON
Last Name:PORTILLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 COLLINS AVE APT 1118
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2252
Mailing Address - Country:US
Mailing Address - Phone:786-256-0610
Mailing Address - Fax:
Practice Address - Street 1:6039 COLLINS AVE APT 1118
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2252
Practice Address - Country:US
Practice Address - Phone:786-256-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR435-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant