Individual
MARIO LUIS DE LA PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9370 SUNSET DR, SUITE A-250, MIAMI, FL 33173-5431
(305) 595-4510
Mailing address
PO BOX 840207, PEMBROKE PINES, FL 33084-2207
(305) 595-4510
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9166474
FL
Other
Enumeration date
12/09/2005
Last updated
06/30/2016
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