Organization
JORGE DE LA PORTILLA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANETH GIRALDO (OFFICE MANAGER)
(305) 220-9207
Entity
Organization
Contact information
Practice address
11880 SW 40TH ST, 420, MIAMI, FL 33175-3584
(305) 220-9207
Mailing address
11880 SW 40TH ST, 420, MIAMI, FL 33175-3584
(305) 220-9207
(305) 223-0137
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME0047966
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036000700
—
FL
Enumeration date
05/20/2011
Last updated
01/27/2016
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