Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 12710 | PR |
NPI | 1063461788 |
---|---|
Provider Name | Dr. Juan C Portela-Arraiza |
First Address | Dorado, PR 00646 |
Second Address | Manati, PR 00674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 22/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74576 | (02) | PR |