Individual
DR. MYRIAM PORTILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
BG1 VIA DEL BOSQUE, BOSQUE DEL LAGO ENCANTADA, TRUJILLO ALTO, PR 00976-6058
(787) 340-1717
(787) 725-3629
Mailing address
BG1 VIA DEL BOSQUE, BOSQUE DEL LAGO ENCANTADA, TRUJILLO ALTO, PR 00976-6058
(787) 340-1717
(787) 725-3629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11189
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11189
LIC ESTATAL
PR
Enumeration date
03/03/2007
Last updated
06/03/2014
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