Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | A11246 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A11246 | CA |
Y | 208D00000X | General Practice Physician | A11246 | CA |
NPI | 1801035886 |
---|---|
Provider Name | Dr. Arturo Portales |
First Address | Tustin, CA 92780-6057 |
Second Address | Tustin, CA 92780-6057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 30/03/2017 |