Individual
MARIO JOSE PORTOCARRERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6550 MAPLERIDGE ST, SUITE 101 AC, HOUSTON, TX 77081-4600
(713) 774-1401
(713) 774-1467
Mailing address
6550 MAPLERIDGE ST, SUITE 101AC, HOUSTON, TX 77081-4600
(713) 774-1401
(713) 774-1467
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01043128A
IN
208000000X
Pediatrics Physician
Primary
J9277
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121331603
—
TX
05
—
121331604
—
TX
Enumeration date
11/08/2006
Last updated
07/31/2013
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