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Organization

GUSTAVO DE LA PORTILLA MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GUSTAVO DE LA PORTILLA MD (PRESIDENT)
(305) 255-1966
Entity
Organization

Contact information

Practice address
11452 QUAIL ROOST DR, MIAMI, FL 33157-6546
(305) 255-1966
(305) 259-0147
Mailing address
11452 QUAIL ROOST DR, MIAMI, FL 33157-6546
(305) 255-1966
(305) 259-0147

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME83614
FL

Other

Enumeration date
11/07/2008
Last updated
04/28/2016
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