Active NPI
Jose M Portela-Vales, D.M.D.
- General Practice Dentistry
- Vega Baja, PR
National Provider Identifier
1063489722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1717
- Practice address
- 67 Calle Jose Julian Acosta
Vega Baja, PR 00693-4436 - Phone
- (787) 858-2066
- Fax
- (787) 858-2066
- NPI assigned
- Mar 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1717 | PR | Primary |
Addresses
Primary practice location
67 Calle Jose Julian Acosta
Vega Baja, PR 00693-4436
Mailing address
751 Calle Sardina
San Demetrio
Vega Baja, PR 00693-3511
Phone (787) 858-2066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240105001574 | PR | Order and Referring Only - Dentist | 1557666773 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1717 | PR | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063489722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "751 CALLE SARDINA",
"address_2": "SAN DEMETRIO",
"city": "VEGA BAJA",
"state": "PR",
"postal_code": "006933511",
"telephone_number": "787-858-2066",
"fax_number": "787-858-2066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 CALLE JOSE JULIAN ACOSTA",
"city": "VEGA BAJA",
"state": "PR",
"postal_code": "006934436",
"telephone_number": "787-858-2066",
"fax_number": "787-858-2066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTELA-VALES",
"first_name": "JOSE",
"middle_name": "M",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PR",
"license": "1717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vega Baja, PR
- Pob Orthodontics, LLC
- Policlinica Familiar Vega Baja
- Policlinica Salud del Norte Inc.
- Policlinicas Salud del Norte
- Silvana Maribel Pons, DDS
- Sebastian Portela
- Prestige Health Care & EMS Services Inc
- Prestige Medical Transport Ambulance Corp
- Primary Medical & Wound Care Center
- Primaxa Medical Alliance LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.