Individual
ANGEL PORTORREAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1743 SUMMERFIELD ST, RIDGEWOOD, NY 11385-8113
(718) 795-7317
Mailing address
1743 SUMMERFIELD ST, RIDGEWOOD, NY 11385-8113
(718) 795-7317
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
226755-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02888622
—
NY
Enumeration date
11/21/2007
Last updated
12/18/2023
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